CMS Releases Medicare Claims and Billing Manual Updates

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):

–  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“Transmittal 2299, dated May 3, 2019, is being rescinded and replaced by Transmittal 2366 dated, October 3, 2019, to add new business requirement 11152.11 and new HIPPS codes file attachment.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.”

This .zip file contains 510 pages of HIPPS codes.   This MLN Matters (11152) corresponds with the R2366OTN and contains this note:


Please share all these pieces of information with your management and billing team.