SNF Patient-Driven Payment Model Billing Issue

Some inpatient hospital and skilled nursing facility (SNF) claims have been processed incorrectly when an interrupted stay is billed at the end of the month. The Centers for Medicare and Medicaid Services (CMS) system incorrectly assigns edits U5601-U5608. Those who billed the interrupted stay correctly but had the claim rejected should modify the billing so that the claim spans the last day of the interrupted stay as follows:

• Bill two months at a time; or
• Bill a month plus the days in the following month that span the interrupted stay plus one day

Adjusting the statement dates to include the entire interrupted stay will allow claims to process and pay correctly. Medicare Administrative Contractors (MACs) will finalize any suspended claims that meet the criteria to allow providers to make corrections and resubmit their claims.

Members should be aware that a SNF cannot submit an adjustment to a paid claim until Oct. 5, 2020. SNFs must cancel the paid claim and all subsequent claims in the same stay and resubmit them in sequential order.

CMS intends to correct the system in the future.

Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820