SNF PDPM Claims Issue

Provider/Supplier Type(s) Impacted: SNF

Reason Codes: Not applicable.

Claim Coding Impact: Not applicable.

Description of Issue: Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly.

Noridian Action Required: Noridian will provide additional updates as they are available.

Provider/Supplier Action Required:
In the interim:

  • Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims
  • Updated 5-21-2020 - Providers should not cancel and rebill. Please hold adjustments until October.
  • Providers are encouraged to submit a complete bill at the time of entry

Proposed Resolution/Solution: CMS expects the issue to be corrected in October.

Date Reported: 02/28/20

Date Resolved:

Last Updated Thu, 21 May 2020 16:48:17 +0000