Implementation of the SNF Patient Driven Payment Model

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

“Transmittal 2299, dated May 3, 2019, is being rescinded and replaced by Transmittal 2366 dated, October 3, 2019, to add new business requirement 11152.11 and new HIPPS codes file attachment. All other information remains the same. This Change Request 11152/Transmittal 2366 will implement the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM).”  Changes are in red on pages 8, 9 and 10 of the transmittal – pages 1, 2 and 3 of the SNF PDPM FY 2020 Input/Output Record Layout.

The 4-page MLN Matters Number: MM11152 (Revised) is intended for SNFs billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

“CR 11152 effectuates changes to the SNF Prospective Payment System (PPS) that are required for the PDPM. These changes were finalized in the FY 2019 SNF PPS Final Rule (83 FR 39162). SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X, (subject to SNF PPS) will be subject to these requirements. Make sure your billing staff is aware of these changes.”