MDS Alert
MDS & Billing News
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Have you incorporated this billing change? Effective for services with dates on or after Jan. 1, 2011, SNF and swing-bed PPS providers must append occurrence code 50 with the ARD for each Health Insurance Prospective Payment System Code (HIPPS) they report on the claim, advises an MLN Matters article. Exception: "HIPPS code AAAxx (where 'xx' is varying digits) does not need an accompanying occurrence code 50," states the article. More instructions: "SNF providers must ensure that each HIPPS code reported on the claim is billed in the order in which that level of care is received for the month," the article advises. " SNF and SB PPS providers, therefore, must include occurrence code 50 for each revenue code 0022 on your 21x and 18x bill types, except where the HIPPS code reported with the 0022 revenue code is AAAxx. Medicare will return such claims as unprocessed if you do not include occurrence code 50." The article goes on to note that you only need to report one occurrence code 50 for two HIPSS code lines both ending in the same two digits for these HIPPS: "xxx05, xxx06, xxx12, xxx13, xxx14, xxx15, xxx16, xxx17, xxx24, xxx25, xxx26, xxx34, xxx35, xxx36, xxx44, xxx45, xxx46, xxx54, xxx55, and xxx56, where 'xxx' is varying digits." CMS revised the instructions because the assessment date data element is not included in the new version of the 8371 electronic format, the article reports. Read the full article, "Revised Instructions for Reporting Assessment Dates under the Inpatient Rehabilitation Facility (IRF), Skilled Nursing Facility (SNF), and Swing Bed (SB) Prospective Payment Systems (PPS)," at www.cms.gov/MLNMattersArticles/downloads/MM7019.pdf. More news: CMS issued an MLN Matters article on Jan. 12 requiring MACs/FIs to request the "Notice of Non- Coverage" or ABN with any Additional Development (Documentation) Request, or ADR, advises Victor Kintz, MBA, CHC, LNHA, RAC-CT, CCA, managing director of operations for Polaris Group based in Tampa, Fla. Read the full article at www.cms.gov/MLNMattersArticles/downloads/MM6988.pdf.
MDS Alert
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Have you incorporated this billing change? Effective for services with dates on or after Jan. [...]