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We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
MLN Matters® Number: MM7552
Related Change Request (CR) #: CR 7552
Related CR Release Date: August 26, 2011
Effective Date: January 1, 2012
Related CR Transmittal #: R2286CP
Implementation Date: January 3, 2012
Provider Types Affected
Physicians, other providers, and suppliers submitting claims to Medicare contractors (carriers, Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Fiscal Intermediaries (FIs), and/or A/B Medicare Administrative Contractors (A/B MACs)) for services provided to Medicare beneficiaries who are in a Part A covered Skilled Nursing Facility (SNF) stay.
What You Need to Know
This article is based on Change Request (CR) 7552 which provides the 2012 annual update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility Consolidated Billing (SNF CB) and how the updates affect edits in Medicare claims processing systems.
By the first week in December 2011:
It is important and necessary for the provider community to view the "General Explanation of the Major Categories" PDF file located at the bottom of each year’s FI/A/B MAC update in order to understand the Major Categories, including additional exclusions not driven by HCPCS codes.
Medicare’s claims processing systems currently have edits in place for claims received for beneficiaries in a Part A covered SNF stay as well as for beneficiaries in a non-covered stay. Changes to HCPCS codes and Medicare Physician Fee Schedule designations are used to revise these edits to allow carriers, A/B MACs, DME MACs, and FIs to make appropriate payments in accordance with policy for Skilled Nursing Facility Consolidated Billing (SNF CB) contained in the “Medicare Claims Processing Manual” (Chapter 6, Section 110.4.1 for carriers and Chapter 6, Section 20.6 for FIs) which is available at http://www.cms.gov/manuals/downloads/clm104c06.pdf on the CMS website.
Please note that these edits only allow services that are excluded from CB to be separately paid by Medicare contractors.
You can find the official instruction, CR 7552, issued to your carrier, FI, A/B MAC, or DME MAC by visiting http://www.cms.gov/Transmittals/downloads/R2286CP.pdf on the CMS website.
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2010 American Medical Association.
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Last Updated: 09/01/2011