SNF PDPM Claims Issue

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

Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:

  • Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims
  • To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly
  • We encourage you to submit a complete bill at the time of entry

The above notification appears in the just-released MLN Connects – February 27, 2020 newsletter.  I’ve added the bolding so the issue stands out in the verbiage.  Be sure to share this information with your Medicare A billers!