Content Section
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Correction to Change Request 3949 to Add 23X Type of Bill
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MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Provider Types Affected
Skilled nursing facilities (SNFs) that use Type of Bill (TOB) 23X to bill Medicare Part B outpatient claims
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 4116 and corrects the billing instructions needed for full implementation of the expedited determinations process for discharges listed in CR 3949. That article can be viewed at http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3949.pdf  on the CMS Web site.
What You Need to Know
The expedited determinations process applies to TOB 23X, which was left off the list of TOBs in CR 3949. The system changes listed in CR 3949 do apply to TOB 23X.
What You Need to Do
Please make your office staff aware of this billing information to ensure accurate claims processing.
Background
As a result of Section 521 of the Benefits Improvement and Protection Act (BIPA), two change requests were published with preliminary instructions regarding the new expedited determinations process for discharges from the following: home health (HH) facilities, hospices, skilled nursing facilities (SNF), and comprehensive outpatient rehabilitation facilities (CORF), effective July 1, 2005.
CRs 3903 and 3949 did not address whether the review process applied to TOB 23X, Skilled Nursing Facility Part B outpatient claims.
Since the publication of CR 3949, the Centers for Medicare & Medicaid Services (CMS) has determined that 23X claims are subject to expedited reviews in certain circumstances. This decision is published on the CMS Web site as part of the Questions and Answers document about expedited determinations (see www.cms.hhs.gov/medicare/bni  ) Also, this CR adds TOB 23X to the Medicare Claims Processing Manual, Section 150.3.3, created by CR3949.
Implementation
The implementation date for the instruction is January 3, 2006.
Additional Information
The official instruction issued to your intermediary regarding this change can be found at http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp on the CMS Web site.
On the above page, scroll down while referring to the CR NUM column on the right to find the links for CR 4116. Click on the links to open and view the files for that CR.
If you have questions, please contact your intermediary at their toll-free number, which can be found at http://www.cms.hhs.gov/medlearn/tollnums.asp 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.
For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/medlearn/matters/.
Pub. 100-4, Transmittal# 712 , CR #: 4116
Medlearn Matters Number: MM 4116
Related CR Release Date: October 14, 2005
Effective Date: Applies to claims submitted on or after January 3,
2006, with dates of service on or after July 1, 2005
Implementation Date: January 3, 2006
Posted: 12/15/2005
CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
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