National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2007 08B, August 2007

Additional Common Working File (CWF) Editing for Skilled Nursing Facility (SNF) Consolidated Billing (CB) (MM5624-R)

Note: This article was revised on July 17, 2007, to reflect a correction made to CR5624. The implementation date was changed to January 7, 2008. All other information remains the same. *
 
Provider Types Affected
Physicians, providers, and suppliers who bill Medicare carriers, Medicare Administrative Contractors (A/B MAC), or Durable Medical Equipment Medicare Administrative Contractors (DME MAC) for services provided to Medicare beneficiaries in SNF stays

What Providers Need to Know
Effective for dates of service on or after April 1, 2001, CR 5624, from which this article is taken, instructs Medicare carriers, A/B MACs, and DME MACs to bypass certain current SNF consolidated billing (CB) Part B and Part B/DMEMAC edits in order to enable the identification of periods when SNF CB edits should not be applied .

Background
CR 5624 instructs Medicare carriers, A/B MACs, and DME MACs (effective April 1, 2001) to bypass SNF CB Part B and Part B/DMEMAC edits when certain inpatient claims are present on Medicare’s history.

These revisions will allow Medicare SNF CB editing to take into account periods of SNF stays that are noncovered by Medicare Part A when services should be payable outside of CB by the Medicare Part B contractor.

Note: CR 5624 does not change the policy for SNF CB. It adjusts Medicare’s claims systems to be in line with current policy.

Medicare contractors (carrier, A/B MAC, or DME MAC) will reopen and reprocess inappropriately denied claims for dates of service on or after April 1, 2001 through January 1, 2008 when you bring such claims to their attention. You should contact your Medicare contractor to have claims reprocessed that you feel were erroneously subject to these consolidated billing edits, and denied. The change will be implemented on January 7, 2008 and claims will be processed correctly as of that date.

Additional Information
You can find the official instruction, CR5624, issued to your carrier, A/B MAC, or DME MAC on the CMS Web site at http://www.cms.hhs.gov/Transmittals/downloads/R1289CP.pdf . As an attachment to CR5624, you will find updated Medicare Claims Processing Manual (100-04), Chapter 6 (SNF Inpatient Part A Billing), Sections 110.2.2 (A/B Crossover Edits), 110.2.4 (Edit for Ambulance Services), and 110.2.5 (Edit for Clinical Social Workers (CSW)).

If you have any questions, please contact your Medicare contractor at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip .
 
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: MM5624 Revised
Pub. 100-4, Transmittal# R1289CP, CR# 5624
Related CR Release Date: July 13, 2007
Effective Date: April 1, 2001
Implementation Date: January 7, 2008

Additional Information Provided by National Government Services, Inc.

* Although this article has been revised, this article was not previously published.