Skilled Nursing Facility (SNF) Claims Processing Updates

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

This MLN Matters Article is for SNFs submitting Type of Bill (TOB) 21X and hospitals submitting TOB 18X to Medicare Administrative Contractors (MACs).

This Article tells you about updates to SNF edits to bypass services related to an emergency room encounter when there is a revenue code of 250 on the same claim. CR 12344 also updates certain Fiscal Intermediary Shared System (FISS) and Common Working File (CWF) edits for overlapping claims when there is a no-pay hospital claim during an interrupted stay. Make sure your billing staff knows about these changes.

CR 12344 is found here