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National
Government Services, Inc.
Medicare Monthly Review Part A and B |
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A
Combined Part A and Part B Newsletter |
MLN Matters. . .Information
for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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MMR-2007 11A, November 2007
MLN Matters Number: MM5734 |
Related Change Request (CR) #: 5734 |
Related CR Release Date: October 19, 2007 |
Effective Date: October 1, 2007 |
Related CR Transmittal #: R1355CP |
Implementation Date: January 22, 2008 |
National Uniform Billing Committee (NUBC) Update on Revenue Codes and Corrected Skilled Nursing Facility (SNF) Spell of Illness Chart
Provider Types Affected
Providers submitting claims to Medicare contractors (fiscal intermediaries (FI) and/or Part A/B Medicare Administrative Contractors (A/B MAC)) for services provided to Medicare beneficiaries
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5734 which updates the Medicare Claims Processing Manual by removing two (2) revenue codes with a “9-Other” subcategory code.
What You Need to Know
The NUBC has discontinued several revenue codes with a “9 Other” designation. CR5734 provides removes revenue codes 0709 and 0719 from the list of “Packaged Revenue Codes in Chapter 3 of the Medicare Claims Processing Manual. In addition, for skilled nursing facilities (SNF), a corrected spell of illness chart is included with CR5734.
What You Need to Do
See the Background and Additional Information sections of this article for further details regarding these changes.
Background
In the process of developing the UB-04 (also known as CMS-1450), the National Uniform Billing Committee (NUBC) reviewed the “9-Other” subcategory codes for necessity, clarity, and redundancy. As a result of their review, several “9” codes were designated as reserved for assignment by the NUBC because the “0-General Classification” codes were deemed sufficient.
Specific revenue codes removed include: 0599, 0709, 0719, 0749, 0759, 0779, 0789, and 0799.
As a result of NUBC’s decision regarding these codes, the Centers for Medicare & Medicaid Services (CMS) is removing two revenue codes, 0709 and 0719, from the Medicare Claims Processing Manual, Chapter 3, Section 20.5.1.1 (Packaged Revenue Codes), effective October 1, 2007. The remaining revenue codes include:
0250, 0251, 0252, 0254, 0255, 0257, 0258, 0259, 0260, 0262, 0263, 0264, 0269, 0270, 0271, 0272, 0275, 0276, 0278, 0279, 0280, 0289, 0370, 0371, 0372, 0379, 0390, 0399, 0560, 0569, 0621, 0622, 0624, 0630, 0631, 0632, 0633, 0637, 0681, 0682, 0683, 0684, 0689, 0700, 0710, 0720, 0721, 0762, 0810, 0819, and 0942.
In addition, CMS discovered that the Skilled Nursing Facility (SNF) spell of illness chart posted in the Medicare Claims Processing Manual, Chapter 6, Section 40.8.1 (Spell of Illness Quick Reference Chart) contained formatting errors.
An updated spell of illness chart is included with CR 5734 and is provided as follows:
| Level of Care
|
Patient’s Medicare SNF Part A Benefits Are Exhausted |
Patient Is In Medicare Certified Area of the Facility * |
If in non-Medicare Area, the Facility Meets the Definition of a SNF ** |
Is the Inpatient Spell of Illness Continued? |
Billing Action |
Medicare Skilled
|
YES |
YES |
N/A |
YES |
Submit Monthly Covered Claim |
NO |
YES |
N/A |
YES |
Submit Monthly Covered Claim |
YES |
NO |
YES |
YES |
Submit Monthly Covered Claim |
NO |
NO |
YES |
YES |
Patient should be returned to certified area for Medicare to be billed. Submit Monthly Covered Claim |
NO |
NO |
NO |
NO |
Facility should determine whether it would be appropriate to a certified area for coverage |
Not Medicare Skilled
|
YES |
NO |
NO |
NO |
Do not submit claim if patient came in non-skilled. Otherwise, submit no-pay claim w/ discharge status code when patient leaves the certified area. |
YES |
YES |
N/A |
NO |
Do not submit claim if patient came in non-skilled. Otherwise, submit no-pay claim w/ discharge status code when patient leaves the certified area. |
NO |
YES |
N/A |
NO |
Do not submit claim if patient came in non-skilled. Otherwise, submit no-pay claim w/ discharge status code when patient leaves the certified area. |
NO |
NO |
YES |
NO |
Do not submit claim if patient came in non-skilled. Otherwise, submit no-pay claim w/ discharge status code when patient leaves the certified area. |
YES |
NO |
YES |
NO |
Do not submit claim if patient came in non-skilled. Otherwise, submit no-pay claim w/ discharge status code when patient leaves the certified area. |
* Whether the facility considers a patient’s bed in the certified area to be a Medicare bed or not has no effect on whether the spell of illness is continued and has no effect on the SNF’s action.
** In some states, licensing laws for all nursing homes have incorporated requirements of the basic SNF definition (Social Security Act §1819(a)(1)). When this is the case, any nursing home in such a state would be considered to meet this definition (see State Operations Manual, Chapter 2, §2164 at http://www.cms.hhs.gov/manuals  on the CMS Web site). |
Additional Information
The official instruction, CR5734, issued to your FI and A/B MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1355CP.pdf  on the CMS Web site.
If you have any questions, please contact your Medicare FI or A/B MAC 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.
| CPT five-digit codes, descriptions, and other data only are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply. |
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