MDS Alert

Published on Thu Mar 05, 2020 PDF

Don’t expect a quick fix, and follow these suggestions in the interim.

Robin Fritter, director of the Division of Provider Relations & Outreach at Centers for Medicare & Medicaid Services, recently alerted SNF stakeholders to some claims issues with the Patient-Driven Payment Model (PDPM) and incorrect payments and adjustment claims processing.

Unfortunately, the issue won’t be fully corrected until October 2020, Fritter says. “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. We will correct this issue in October,” she explains.

Meanwhile, Fritter says SNFs should:

“Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims.”

“To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly.”

Fritter also recommends facilities “submit a complete bill at the time of entry.”