News Tagged as SNF

From: CMS E-mail Notification – 1/10/12

Text of CMS E-mail:

CMS has developed a workaround for Skilled Nursing Facility (SNF) and Swing Bed (SB) claims incorrectly returned to the provider for assessment reference date (ARD) reason code 31742 to allow these claims to process. Providers with claims returned due to the incorrect application of this reason code should send them back to Medicare for processing. Be sure to bill the correct ARDs with occurrence code 50 prior to sending these claims to Medicare for processing.

Transmittal 3 – December 2011

This transmittal impacts SNF cost reporting periods beginning on or after January 1, 2012.  It incorporates a revision required by ACA Section 6104 “Reporting of Direct Care Expenditures.” 

This ACA provision requires SNFs to separately report expenditures for wages and benefits for direct care staff (breaking out (at a minimum) registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff).  A new cost report form was added S-3, Part V for the collection of this data.  Several other changes/clarification were made in and described in this transmittal.

Read more:

SNF Cost Report Forms CMS-2540-10

SNF Medicare Claims Processing Issue

From: CMS e-mail – 12/7/11

Text of e-mail

A claims processing issue was identified that has affected payment of some Part B claims for SNF patients for dates of service from Saturday, October 1, 2011 through Monday, November 21, 2011.  Some Part B claims for SNF patients submitted to Medicare during October and November 2011 have been erroneously denied by Medicare’s claims processing system. In other instances, the claims processing system has paid and then identified a Medicare “overpayment” on these claims in error.  

If you submitted a Part B claim for a SNF patient, you may receive a system-generated Demand Letter from Medicare, or you may see a notification for a payment offset on your Remittance Advice.

Your Medicare Claims Administration Contractor is working with CMS to remedy this problem in the claims processing system so that appropriate payment adjustments can be made. 

We are asking providers not to appeal these claims at this time. Because these are erroneous adjustments in Medicare’s claims processing system, submitting an appeal may slow down the correct adjustment of your claim.

Your Medicare Claims Administration Contractor will notify you when the adjustment process for these claims is initiated and keep you updated so that you can anticipate when your claims (along with any notifications for payment recovery) will be adjusted. We apologize for any inconvenience.

SNF PPS Fact Sheet

MLN – September 2011

CMS recently updated the SNF PPS fact sheet.  This is a helpful document to provide your staff with an overview of the Medicare payment system in place for SNF services.

I have provided several links that address the Medi-Cal cuts approved by CMS on October 27, 2011.  Many of these reductions are retroactive to June 1, 2011:

DHCS News Release   From DHSC – 10/27/11

Summary of Provider Rate Reductions Approved by CMS   From DHCS – 10/27/11 

Links to CMS Approved State Plan Amendments – 10/27/11   From DHCS – 10/27/11

California Hospital Association Sues to Stop Medi-Cal Cuts   From: Sacramento Business Journal – 11/3/11 

Excerpt from Article:  Declaring that reduced Medi-Cal payments to skilled nursing units inside hospitals will have “an unprecedented” adverse impact on California hospitals and the Medi-Cal program as whole, the California Hopital filed a lawsuit Wednesday to stop them.

The cuts were approved by the federal Centers for Medicare and Medicaid Services last week and are expected to take effect in the next month or two. Medicaid is called Medi-Cal in California.

Read more…

Regional Medicare Swing Bed-Rates – Calendar 2012

Transmittal 446 – 9/30/11

This transmittal updates the regional Medicare Swing Bed rates for calendar 2012.  The rates for 2010 – 2012 are summarized below:

SNF PPS Final Rule Correction – FFY 2012

CMS-1351-CN; 9/26/11 FR

Corrections were issued by CMS on September 26, 2011 for the original final SNF PPS rules that were released on August 8, 2011.  There were omissions that impacted the wage index values for Dothan, AL (CBSA 20020), Monroe, LA (CBSA 33740) in Table A and the Statewide wage index for Louisiana (19) in Table B.  Click here to locate the download link containing the updated table identified as “CMS 1351-CN Wage Index Tables for FY 2012 [ZIP, 83KB]”.

SNF PPS Pricer Upate – FY2011

CMS Posted – 9/9/11

E-mail from CMS:

The FY 2011 SNF PC Pricer has been updated with July 2011 provider data on the page/URL: http://www.cms.hhs.gov/PCPricer/04_SNF.asp, under the “Skilled Nursing Facilities (SNF PPS) PC Pricer”. If you use the FY2011 SNF PC Pricer please go to the page above and down load the SNF PC Pricer posted 09/09/2011 with the more current provider data.

Transmittal 1

This transmittal introduces Chapter 41, Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report, Form CMS-2540-10, which contains instructions for the completion of the new cost report forms to be filed by skilled nursing facilities (SNF’s) and SNF complexes.