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SNF Claims Incorrectly Cancelled January 26 - February 16

Dan Ciolek

From January 26 through February 16, 2020, a software issue caused many Skilled Nursing Facility (SNF) Medicare Part A claims to be incorrectly cancelled with a message that there was no three-day qualifying hospital stay. The Centers for Medicare & Medicaid Services (CMS) has informed AHCA that this issue has been corrected and was not caused by the recent implementation of the SNF Patient Driven Payment Model. CMS has provided the following guidance to receive correct payments.  Please share with your billing staff. 

If your claims were incorrectly cancelled, re-bill them in sequential order to receive payment.

Note:

• Claims need to process in date of service order for each stay for the Variable Per Diem (VPD) to calculate correctly 
• Submit claims in sequence and wait at least 2 weeks before billing subsequent claims 
• Some of the affected claims with older dates of service will require a timely filing exception; enter “Resubmission due to non-qualifying stay” in the remarks field 
• Contact your MAC to receive the Medicare Beneficiary Identifier (MBI) for deceased beneficiaries 

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