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SNF Claims Incorrectly Cancelled

The Centers for Medicare and Medicaid Services (CMS) has identified a software issue which incorrectly cancelled certain Skilled Nursing Facility (SNF) Medicare Part A claims. From Jan. 26th through Feb. 16, 2020, SNF claims were incorrectly cancelled with a message that there was no three-day qualifying hospital stay. CMS has corrected this issue.

SNF providers with claims that were incorrectly cancelled should re-bill them in sequential order to receive payment. Claims need to process in order by date of service for each stay for the Variable Per Diem (VPD) to calculate correctly. In addition, SNF providers should be aware that:

  • Claims must be submitted in sequence, and they should wait at least two weeks before billing subsequent claims;
  • Some of the affected claims with older dates of service will require a timely filing exception; enter “Resubmission due to non-qualifying stay” in the remarks field;
  • This issue was not caused by the recent implementation of the SNF Patient-Driven Payment Model (PDPM); and
  • Providers should contact the Medicare Administrative Contractor (MAC) to receive the Medicare Beneficiary Identifier (MBI) for deceased beneficiaries.

Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820