Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)

CR11632 alerts providers that CR11152 erroneously made modifications to edits and the Centers for Medicare & Medicaid Services (CMS) needs to omit and make corrections to allow for proper claims processing. (See the related MLN Matters article at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11152.pdf.) Make sure your billing staffs are aware of these changes.

BACKGROUND

CR11632 implements changes to the SNF Prospective Payment System (PPS), specifically changes required for the Patient Driven Payment Model (PDPM). SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X (subject to SNF PPS) are subject to these requirements. No policy changes exist with CR11632.

The corrected edits allow proper adherence to Medicare's interrupted stay policy. That policy is as follows for SNF PDPM and should only apply to SNF PPS providers:

  • If a resident is discharged from a SNF and returns to the same SNF by the end of the third day of the interruption window, the resident’s stay is treated as a continuation of the previous stay for purposes of resident classification and the variable per diem adjustment schedule.

Source

  • CMS MLN Connects dated April 1, 2020

 

            Last Updated Thu, 07 May 2020 19:22:03 +0000