SNF PPS PDPM Claims Processing Updates to Current Editing

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

CMS posted Transmittal 12023 on May 8, 2023:

This Change Request (CR) implements changes to enhance current claims processing edits. 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 swing bed TOB 18X, (subject to SNF PPS) will be subject to these requirements. The changes will also update hospital overlap edits when billing during an interrupted stay where the hospital stay extends to the next month. This CR will modify claims processing to adhere to current policy. No policy changes exist with this CR.

A corresponding 2-page MLN Matters Number: MM13149 provides some details: