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Video Slideshow Presentation from Thu Nov 3 ¡°Skilled Nursing Facility PPS MDS 3.0 and RUG-IV Policies and Clarifications¡± National Provider Call Available on CMS YouTube Channel [¡è]

CMS has posted a video slideshow presentation from the Thu
Nov 3 National Provider Call on the ¡°Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Minimum Data Set (MDS) 3.0 and Resource Utilization Group-Version 4 (RUG-IV) Policies and Clarifications¡± to the CMS YouTube Channel.

During this National Provider Call, CMS subject matter experts provided an overview of the policies, along with clarifications on the SNF PPS FY2012 policies related to the MDS 3.0. The agenda included:

¡◊ Allocation of Group Therapy
¡◊ Changes to the MDS Assessment Schedule
¡◊ End of Therapy (EOT) Other Medicare Required Assessment (OMRA) Clarifications
¡◊ End Of Therapy with Resumption (EOT-R)
¡◊ Change of Therapy (COT) OMRA
¡◊ Question and answer session

For more information on SNF PPS and other available educational resources, please visit the SNF PPS FY2012 RUG-IV Education&Training webpage.

¨ª Additional material related to Skilled Nursing Facilities in today¡¯s e-News¡œ [next]
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Skilled Nursing Facility FY2012 PC Pricer Revised [¡è]

The Skilled Nursing Facility (SNF) FY2012 PC Pricer has been revised to correct an intermittent problem, and has been updated on the CMS website. If you use the FY2012 SNF PC Pricer, please visit http://www.CMS.gov/PCPricer/04_SNF.asp and download the revised file.

¨ª Additional material related to Skilled Nursing Facilities in today¡¯s e-News¡œ [previous]
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Temporary Workaround for the Assessment Reference Date Reason Code 31742 for Skilled Nursing Facility and Swing Bed Claims

CMS has developed a workaround for Skilled Nursing Facility (SNF) and Swing Bed (SB) claims incorrectly returned to the provider for assessment reference date (ARD) reason code 31742 to allow these claims to process. Providers with claims
returned due to the incorrect application of this reason code should send them
back to Medicare for processing. Be sure to bill the correct ARDs with
occurrence code 50 prior to sending these claims to Medicare for processing.

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Further Information about Medicare Claims Processing Issue Related to Part B Services for Skilled Nursing Facility (SNF) Patients


Because of a claims processing problem, some Part B claims for SNF patients submitted to Medicare during October and November 2011 have
been erroneously denied by Medicare¡¯s claims processing system. In other
instances, the claims processing system has paid and then identified a Medicare
¡°overpayment¡± on these claims in error.
 
CMS is working with its contractors to identify all claims that were denied in error as well as any overpayments that were identified erroneously and resulted in a demand letter. The denied claims will be reprocessed and the erroneous overpayments adjusted so that in most cases there will be no impact upon the provider. Where a demand letter was sent in error, the Medicare Claims Administration Contractor (MAC) will send you an acknowledgement letter that the overpayment was removed.
 
In a few cases, an overpayment may have been collected prior to the MAC having determined that the demand letter was sent in error. In such instances, the MAC will automatically process an adjustment. We are asking providers not to appeal these claims at this time. Submitting an appeal may slow down the correct adjustment of your claim. (Please note that if another valid overpayment exists, the money collected will first be applied to it and the provider will be notified accordingly.)

Your MAC will advise you through its website and its listservs when it expects to complete this process so that you can anticipate when your claims will be adjusted or your erroneous overpayments removed. We thank you for your patience and we apologize for any inconvenience.

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Medicare Claims Processing Issue Related to Part B Services for
Skilled Nursing Facility (SNF) Patients

A claims processing issue was identified that has affected payment of some Part B
claims for SNF patients for dates of service from Sat Oct 1 through Mon Nov
21.

Some Part B claims for SNF patients submitted to Medicare during Oct and Nov 2011 have been erroneously denied by Medicare’s claims processing system. In other instances, the claims processing system has paid and then identified a Medicare “overpayment” on these claims in error.

 If you submitted a Part B claim for a SNF patient, you may receive a
system-generated Demand Letter from Medicare, or you may see a notification for a payment offset on your Remittance Advice.

 Your Medicare Claims Administration Contractor is working with CMS to remedy this problem in the claims processing system so that appropriate payment adjustments can be made.

We are asking providers not to appeal these claims at this time. Because these are erroneous adjustments in Medicare’s claims processing system, submitting an
appeal may slow down the correct adjustment of your claim.

 Your Medicare Claims Administration Contractor will notify you when the adjustment process for these claims is initiated and keep you updated so that you can anticipate when your claims (along with any notifications for payment recovery) will be adjusted. We apologize for any inconvenience.

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Systems Issue Impacting Skilled Nursing Facilities (SNF) Which Bill Electronically Using New Health Insurance Prospective Payment System (HIPPS) Codes

CMS recently developed a new Change of Therapy (COT) Other
Medicare Required Assessment (OMRA) for the SNF PPS and developed a mechanism to allow providers to report a Resumption of Therapy on an End of Therapy (EOT) OMRA. In addition, several new Assessment Indicators (AIs) were created to identify that a COT OMRA was completed and to distinguish between cases where an EOT OMRA is performed with the resumption items completed and cases where an EOT OMRA is completed without the resumption items completed. The new AIs were introduced in Chapter 6, Section 6.4, of the new Minimum Data Set (MDS) manual located at: http://www.CMS.gov/NursingHomeQualityInits/downloads/MDS30RAIManual.zip.
As a result of these new AIs, CMS must add approximately 1500 new HIPPS codes to the Fiscal Intermediary Shared System (FISS). The HIPPS master list located at http://www.CMS.gov/ProspMedicareFeeSvcPmtGen/02_HIPPSCodes.asp contains these new codes.
As a result of these new AIs, an unforeseen claims processing system issue surfaced for claims that are submitted electronically.  The correction for this issue will take place on Mon Dec 5. In the meantime, providers may submit claims that contain these HIPPS codes directly via FISS Direct Data Entry (DDE) screens or hold these claims until after the system fix
is implemented on Mon Dec 5.
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From the MLN: “Skilled Nursing Facility Prospective Payment System” Fact Sheet Revised

The “Skilled Nursing Facility Prospective Payment System” Fact Sheet (ICN 006821) has been revised. It includes the following information: background and elements of the Skilled Nursing Facility Prospective Payment System.
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2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning Sun Jan 1, 2012


In May 2011, CMS released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) (form CMS-R-131), which will replace the 2008 version of this form. The 2011 version contains no substantive changes from the 2008 version of the notice and was approved by the Office of Management and Budget. The 2008 and 2011 ABN notices are identical except that the release date of ¡°3/11¡± is printed in the lower left hand corner of the new version. The ABN is used by all providers, practitioners, and suppliers paid under Medicare Part B, as well as hospice providers and religious non-medical healthcare institutions (RNHCIs) paid exclusively under Part A.

When the 2011 ABN was posted to the CMS website on Mon May 16, CMS announced a mandatory use date of Thu Sep 1 and permitted providers and suppliers to begin using the new form immediately. Subsequently, we received requests from the industry to extend this deadline in order to permit providers and suppliers with pre-printed stockpiles of ABNs time to exhaust their supplies.

 Providers and suppliers are allowed to use either the 2008 or 2011 version of the ABN through the end of this year; beginning Sun Jan 1, 2012, they must begin using the 2011 version. ABNs issued after Sun Jan 1 that are prepared using the
2008 version of the notice will be considered invalid by Medicare contractors.
2008 versions of the ABN that were issued prior to Sun Jan 1 as long-term
notification for repetitive services delivered for up to one year will remain
effective for the length of time specified on the notice.

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Skilled Nursing Facility / Swing Bed Billing Clarification
As a clarification for usage of the Occurrence Code 16 (date of last therapy) on inpatient Skilled Nursing Facility (SNF) / Swing Bed (SB) claims, please note that only one occurrence code may be billed on a single claim. Therefore, claims would use the final date therapy was provided in relation to the latest EOT OMRA applicable.


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Illinois Nursing Home Administrator's Association PO Box 111, Lanark, IL 61046-0111