Second Update to CR 11152 Implementation of SNF PDPM Corrects Previous Errors

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

No policy changes are conveyed in Change Request: 11632 but the posting is something you should be aware of.  CMS is correcting previous modification errors with edits made previously.  Here’s the gist of this CR (bolding added by me for emphasis):

SUMMARY OF CHANGES: This Change Request (CR) contains updates/corrections to the SNF PDPM.


A. Background: This Change Request (CR) implements changes to the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), specifically implementing changes required for the Patient Driven Payment Model (PDPM). This CR is applicable to the Fiscal Intermediary Shared System (FISS) and the Common Working File (CWF). 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. CR 11152 erroneously made modifications to some edits and CMS needs to omit and make corrections to allow for proper claims processing.

The interrupted stay policy is as follows for SNF PDPM and should only apply to SNF PPS providers, if a resident is discharged from a SNF and returns to the same SNF by the end of the third day of the interruption window, the resident’s stay is treated as a continuation of the previous stay for purposes of resident classification and the variable per diem adjustment schedule.

B.Policy: No policy changes exist with this CR.