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Electronic Mailing Lists
Billing - Skilled Nursing Facilities
The following questions were asked during the January 31, 2008 SNF Billing webinar.
- We have received reason code error 31992 instead of 70LLC for a PA provider. Is there a way other than calling the Customer Contact Center to have the claims reprocessed with the correct reason code 31992?
- Referring to the first claim example, is this someone who previously used 100 days?
- Is a value code for coinsurance a required field?
- What if the patient has dropped to non-skilled and no denial is needed. Do we have to submit a no-pay claim?
- If in the middle of month, during a no-pay bill period (210), the patient goes on 1 day hospital leave of absence, which would require two occurrence span codes 74 on the claim. However, FISS returns this claim to provider. Do we split the claims on LOA?
- I have claims that span August 2007 to October 31, 2007 and they did not process because it covered a fiscal year. Has that error been corrected?
- What is the date the standard process for billing benefits exhaust and no payment claims became effective?
- What admission date needs to be used for each of the exhaust and no-pay claims?
- If a resident is admitted on 11/15/2006 as non-skilled and is discharged on 01/08/2008, should our no-pay claim (210) reflect 11/15/2006-01/08/2008 for 419 days?
- It was my understanding that I could submit both no pay claims and Medicare B at the same time, because of occurrence span code 74. However, are you now stating I need to wait on submitting the Medicare B until Medicare has finished processing my no pay claims?
- Benefit exhaust claims are suspending and taking a long time to cycle through, even if it's a clean claim (have some at 60+ days). Does Highmark have plans to fix the processing?
- If a resident is discharged to the hospital, do I code my bill as a 214 with the status code of 02? Also, do I need do to more than 3 210 bills once a patient is cut from skilled services?
- If a patient receives multiple tests per month, when is the ABN provided and/or how often?
- How many 210 bills do I bill once the patient is no longer skilled?
- Why are the 210 no pay claims not crossing over to supplemental insurers?
- Should the admission date on the no pay claim be the original Medicare date or should it be the admission date for the no-pay status?
- Is the hospital stay required on the 210 no pay claim?
- In a long term care (LTC) setting, residents could be here for a number of years. Can we or should we submit no-pay (210) claims that span 6 months to a year?
- If you get a CERT request and send the records, will you get an answer back?
- What is the difference between the 09 and 11 code?
- When is the skilled 213 benefits exhaust claims U5701 reason code going to be corrected?
- Is the A3 condition code reported has been exhausted?
- I a CCRC, must all permanent patients of a Medicare certified bed have no bills submitted even though they will not be charged?
- It was indicated that glucose information was provided at IOM. How do I access that that information?
- If occurrence code A3 is no longer needed on the benefits exhaust claim, then the next benefit period starts to count the 60 days by the first no-pay claim submitted?
- If a resident remains at a skilled level of care, do we continue to submit a benefit exhaust claim until the drop to a lower level of care and then stop billing that with the last covered day?
- What is the required effective date for the no pay bills?
- The No-Pay and the Exhaust claims would only be effective for NEW Residents that were admitted to our facility in October 2006?
- I have a resident who exhaust their 100 days, they remain at a skilled level of care. Do I continue to bill my exhaust claim until they drop to a lower level of care and the use my code 22 and stop billing? Then start billing the no-Pay claim?
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Calling into the contact center is the only way these rejected claims can be processed for a more appropriate reason code. Currently, all 210, condition code 21 claims, will now suspend to SMRFDS with reason code 7RFDS to ensure a more appropriate reason code is assigned. These claims are being processed in the order they are received.
Date Posted: 02/21/2008
Referring to the first claim example, is this someone who previously used 100 days?
In the example used, the patient exhausted SNF Part A benefits days on a prior SNF claim.
Date Posted: 02/21/2008
Is a value code for coinsurance a required field?
Yes, this is a required field, a great tip is that you can key $1.00 and the system will calculate the amount for you, which is a great option because if you calculate incorrectly, the claim will be returned. Keying $1.00 will avoid this.
Date Posted: 02/21/2008
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Yes, SNF providers must submit no-payment bills for beneficiaries who previously received Medicare-covered care and subsequently dropped to a noncovered level of care but continue to reside in a Medicare-certified area of the facility. The no pay (210) claim must be submitted to extend the benefit period. Please refer to CMS change request CR 4292 and the CMS Pub. 100-04, Chapter 6, §40.8.
Date Posted: 02/21/2008
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You would not split your claim. The occurrence span code 74, reported on the 210 claim, includes all days within the statement covers period of that 210 claim. Therefore, if the leave of absence day fell within the statement covers period of the 210 claim, there would not be a need for 2 occurrence span codes 74.
Date Posted: 02/21/2008
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You are required to split claims that span the federal fiscal year end (September 30). The issue you are referencing impacted claims that spanned October 1. This has been resolved. If you need further assistance with your claims, please call the customer contact center at 1-866-488-0545 (MD/DC) or 1-800-560-6170 (PA).
Date Posted: 02/21/2008
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This standard process is became effective October 1, 2006 and applies only to SNF residents who are newly admitted to, or are in, Medicare Part A stays on or after October 1, 2006.
Date Posted: 02/21/2008
What admission date needs to be used for each of the exhaust and no-pay claims?
Report the admission date that applies to the sequence of claims.
Date Posted: 02/21/2008
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If the resident is non-skilled upon admission, a no-pay claim (210) is required only if the resident was admitted to the Medicare-certified area of the facility. Assuming this is the scenario, you are permitted to bill upon discharge, which may span multiple months. However, SNF providers may not span the federal fiscal year end (September 30). Therefore, you would need to split the claim at the federal fiscal year end. (Reference: CMS Pub. 100-04, Ch. 6 §30)
Date Posted: 02/21/2008
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The reporting of occurrence span code 74 allows your no-pay (210) claims to be submitted without overlapping previously processed 22X claims.
Date Posted: 02/21/2008
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Highmark Medicare Services is meeting the CMS standards to process claims within 30 days. If you are experiencing long delays in getting these processed, please contact our customer contact center at 1-800-560-6170 (PA) or 1-866-488-0545 (MD/DC) and provide examples.
Date Posted: 02/21/2008
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Yes, you need to use the appropriate bill type and patient status code to indicate the discharge. Regarding no-pay claims (210), these are required when a patient is no longer skilled and continues to reside in the Medicare-certified area of the facility. Change Request (CR) 4292 instructions allow you to submit these monthly or upon discharge.
Date Posted: 02/21/2008
If a patient receives multiple tests per month, when is the ABN provided and/or how often?
If an ABN is required, it needs to be provided each time the service is performed. For more information on the ABN process, please refer to the CMS website through the following link: http://www.cms.hhs.gov/BNI/ or the CMS Pub. 100-04, Ch. 30, Financial Liability Protections.
Date Posted: 02/21/2008
How many 210 bills do I bill once the patient is no longer skilled?
Once a patient is no longer skilled and remains in the Medicare-certified area of the facility, you are required to bill until discharge. The number of claims submitted would depend on if you submit these on a monthly basis or you wait until the patient is discharged from the facility.
Date Posted: 02/21/2008
Why are the 210 no pay claims not crossing over to supplemental insurers?
There are ANSI codes that appear on the remittance advice to indicate that a claim was crossed over to the supplemental insurer. Any questions, please contact the supplemental insurer.
Date Posted: 02/21/2008
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The admission date should be the date the patient was admitted to the skilled nursing facility.
Date Posted: 02/21/2008
Is the hospital stay required on the 210 no pay claim?
The hospital qualifying stay is required on all inpatient claims (21X).
Date Posted: 02/21/2008
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SNFs are permitted to bill no-pay claims upon discharge, which may span multiple months. However, SNF providers may not span the federal fiscal year end (September 30). Therefore, you would need to split the claim at the federal fiscal year end. (Reference: CMS Pub. 100-04, Ch. 6 §30)
Date Posted: 02/21/2008
If you get a CERT request and send the records, will you get an answer back?
The only time you will know about a CERT review decision is if there was an error assessed.
Date Posted: 02/21/2008
What is the difference between the 09 and 11 code?
Value code 09 is defined as the Medicare coinsurance amount in the first calendar year in billing period. Value code 11 is defined as Medicare coinsurance amount in the second calendar year in the billing period. For example, a claim is submitted for dates of service 12/28/07 through 01/31/08, and coinsurance days are applicable for the all days reported on the claim, report the coinsurance amounts for 2007 and 2008 as follows:
- Value code 09/$ 496.00
- Value code 11/$ 3968.00
Date Posted: 02/21/2008
When is the skilled 213 benefits exhaust claims U5701 reason code going to be corrected?
We are working on this issue and will let you know via listserv.
Date Posted: 02/21/2008
Is the A3 condition code reported has been exhausted?
With the implementation of change request (CR) 4292, providers no longer report this code on the benefit exhaust claim. The Medicare Common Working File (CWF) to assign the correct benefits exhaust denial to the claim and appropriately post the claim to the patient’s benefit period.
Date Posted: 02/21/2008
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As long as patient resides in the Medicare-certified area of the facility, a clam must be submitted.
Date Posted: 02/21/2008
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Information regarding blood glucose monitoring in a SNF can be found in our local coverage determination (LDC) and frequently asked questions through the following links:
- www.highmarkmedicareservices.com/policy/parta/l1/pafi-l72.html
- www.highmarkmedicareservices.com/policy/parta/l1/md-l72.html
- www.highmarkmedicareservices.com/faq/parta/snf_lpet/snf_blood_glucose.html
Date Posted: 02/21/2008
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The reporting of occurrence code 22 and date of last skilled day begins the 60-day break count.
Date Posted: 02/21/2008
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If a resident continues to be skilled after benefits exhaust, you must submit benefits exhaust claims, on a monthly basis, until skilled care ends; reporting occurrence code 22 on that claim. Once skilled care ends and the resident continues to reside in a Medicare-certified area of the facility, you begin submitting no-pay (210) claims until discharge.
Date Posted: 02/21/2008
What is the required effective date for the no pay bills?
This standard process is became effective October 1, 2006 and applies only to SNF residents who are newly admitted to, or are in, Medicare Part A stays on or after October 1, 2006.
Date Posted: 02/21/2008
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Yes, this standard process is became effective October 1, 2006 and applies only to SNF residents who are newly admitted to, or are in, Medicare Part A stays on or after October 1, 2006.
Date Posted: 02/21/2008
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Yes. If a resident continues to be skilled after benefits exhaust, you submit benefits exhaust claims on a monthly basis until skilled care ends; reporting occurrence code 22 on that claim. Once skilled care ends and the resident continues to reside in a Medicare-certified area of the facility, you begin submitting no-pay (210) claims until discharge.
Date Posted: 02/21/2008