SNF and Swing-Bed Provider Cross Federal Fiscal Year (FY) Billing Skilled Nursing Facility (SNF) and Swing-Bed providers must bill their inpatient claims per the CMS Claims Processing Manual, Publication 100-4, Chapter 6, Section 30. Separate bills are required for each Federal Fiscal Year (FY) for admissions that span the annual update effective date (October 1) or when updates that may occur at other points in the year when required by legislation. It has been brought to our attention that in the past, SNF and Swing-Bed inpatient claims were being processed incorrectly when the inpatient claims crossed the Federal FY end date and the discharge date occured on the next Federal FY start date (October 1). This means that if a claim was submitted with an admission date of 09/15/05 and a discharge date of 10/01/05, the claim would process to adjudication. Effective immediately, any claims submitted on or after October 1, 2006 will no longer be able to cross the Federal FY end date. This means that any SNF or Swing-Bed inpatient 21X or 18X claims that have a discharge date of 10/01/XX will be RTP with reason code 32148. Providers must split the bill in order to process these claims. The first claim must have a through date of 09/30/XX with a patient status 30. The subsequent claim will need to be submitted as a noncovered 210 or 180 type of bill, from and through date 10/01/XX, condition code 21, noncovered charges, a default RUGS code AAA00 and a nominal noncovered charge for the accommodate revenue line ($.01). If a claim has previously processed that crossed the Federal FY end with a 10/01/XX and now needs to be adjusted, the new rules will apply. The claim should be adjusted to back up the through date to 09/30/XX with a patient status 30 and then submit the noncovered discharge claim. Please Note: In the past, Pricer changes have occurred at other points of the year. Please review the narrative of reason code 32148 for specific dates that this has occurred. Splitting claims would need to occur for those dates also.
If a patient is discharged on one of these dates the claim needs to be split billed. The discharge claim should be submitted as noncovered with one noncovered day, condition code 21, the default HIPPS code of AAA00 and a nominal noncovered charge for the accommodation revenue code (e.g., $.01). Correct and resubmit if appropriate. © All current procedural terminology (CPT) codes and descriptors copyrighted by the American Medical Association. |
