Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
CMS has been very busy the past week with all things PDPM! Updates to Medicare claims and billing manuals were no exception. All updates are effective and being implemented on November 5, 2019 (revised verbiage is identified by the red ink):
- Chapter 4 – Physician Certification and Recertification of Services of the Medicare General Information, Eligibility and Entitlement manual. The actual modification is 1 page following the transmittal verbiage (R126GI).
- Chapter 3 – Duration of Covered Inpatient Services and Chapter 8 – Coverage of Extended Care (SNF) Services Under Hospital Insurance of the Medicare Benefit Policy manual. The actual 8 pages of modifications for both chapters start on page 5 of the transmittal (R261BP).
- Chapter 6 – SNF Inpatient Part A Billing and SNF Consolidated Billing of the Medicare Claims Processing Manual. R4409CP is 30 pages in length with the actual modifications beginning on page 6 of the transmittal. There is a great deal of red ink (new information) on these pages! The updates to this chapter/manual include:
– 120- Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)
– 1 – HIPPS Updates and Structure Changes
– 2 – Interrupted Stay Policy
– 3 – Variable Per Diem (VPD) Adjustment
– 4 – AIDS Adjustments
– 5 – Transition Claims
– 6 – Default Billing
The SNF Spell of Illness Quick Reference Chart is updated on pages 23 and 24.
In addition, CMS issued this 10-page transmittal: Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (R2336OTN) with this verbiage:
“Transmittal 2299, dated May 3, 2019, is being rescinded and replaced by Transmittal 2366 dated, October 3, 2019, to add new business requirement 11152.11 and new HIPPS codes file attachment.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.”
Please share all these pieces of information with your management and billing team.