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MIR-2006-11AB, November 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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2007 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB)
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare carriers, durable medical equipment regional carriers (DMERCs) or DME Medicare Administrative Contractors (DME MACs), and fiscal intermediaries (FIs) for services provided to Medicare beneficiaries in SNFs
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5283, which provides the 2007 annual update of HCPCS codes for SNF CB and how the updates affect edits in Medicare claims processing systems.
What You Need to Know
CR5283 provides updates to HCPCS codes that will be used to revise common working file (CWF) edits to allow carriers and FIs to make appropriate payments in accordance with policy for SNF CB in the Medicare Claims Processing Manual (Publication 100-04), Chapter 6, Section 110.4.1 for carriers and Chapter 6, Section 20.6 for FIs.
What You Need to Do
See the Background and Additional Information sections of this article for further details regarding this update.
Background
Medicare’s claims processing systems currently have edits in place for claims received for beneficiaries in a Part A covered SNF stay as well as for beneficiaries in a noncovered stay. Changes to Healthcare Common Procedure Coding System (HCPCS) codes and Medicare Physician Fee Schedule designations are used to revise these edits to allow carriers, DMERCs/DME MACs, and FIs to make appropriate payments in accordance with policy for SNF CB contained in the Medicare Claims Processing Manual. These edits only allow services that are excluded from CB to be separately paid by carriers and/or FIs.
Note: It is important and necessary for the provider community to view the “General Explanation of the Major Categories” PDF file located at the bottom of each year’s FI update listed at http://www.cms.hhs.gov/SNFConsolidatedBilling/  on the CMS Web site in order to understand the Major Categories including additional exclusions not driven by HCPCS codes. |
Implementation
The implementation date for CR5283 is January 2, 2007.
Additional Information
For complete details, please see the official instruction issued to your carrier, DMERC, DME MAC or intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1068CP.pdf  on the CMS Web site.
If you have any questions, please contact your carrier, DMERC, DME MAC, or intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5283
Pub. 100-4, Transmittal# R1068CP, CR# 5283
Related CR Release Date: September 29, 2006
Effective Date: January 1, 2007
Implementation Date: January 2, 2007
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