Shared Savings Program SNF Affiliates’ Requirement to Include Demonstration Code 77 on SNF 3-Day Rule Waiver Claims

MLN Matters Number: MM11290
Related CR Release Date: August 2, 2019
Related CR Transmittal Number: R2330OTN
Related Change Request (CR) Number: 11290
Effective Date: January 1, 2020
Implementation Date: January 6, 2020

CR 11290 requires Skilled Nursing Facility (SNF) affiliates of ACOs participating in the Shared Savings Program to include demonstration code 77 in the treatment authorization field on claims when the SNF affiliate intends for the claim to be subject to the SNF 3-day rule waiver. Beginning with admissions on or after January 1, 2020, ACO SNF affiliates need to submit demonstration code 77 on claims in the treatment authorization field to serve as the SNF affiliate's attestation that the eligibility requirements for using a SNF 3-Day Rule Waiver have been met. Should Medicare systems determine the beneficiary is deemed ineligible for services under the demonstration code 77, MACs will reject the claim with the following messages:

  • Claim Adjustment Reason Code (CARC) 272: Coverage/program guidelines were not met.
  • Remittance Advice Remark Code (RARC) N564: Patient did not meet the inclusion criteria for the demonstration project or pilot program.

This waiver is only available to ACOs that are eligible and approved to use the SNF 3-day rule waiver. Make sure your SNF billing staffs are aware of the requirement to include demonstration code 77 in the treatment authorization field.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11290.

            Last Updated Tue, 06 Aug 2019 10:30:50 +0000