Wednesday, August 1, 2018

CMS Quarterly Update of SNF Consolidated Billing Codes Fixes Errors Impacting 2016-2018 SNF PPS

Dan Ciolek

SNF billers are advised to review a recent Centers for Medicare and Medicaid Services (CMS) MLN Matters article MM10852 titled “Quarterly Update to 2018 Annual of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement.”   This article describes updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS). Changes these changes allow Medicare Administrative Contractors (MACs) to make appropriate payments in accordance with policy for SNF CB in the “Medicare Claims Processing Manual”, Chapter 6, Section 20.6. 

Included in the updated code list are the following codes that should not have been subject to consolidated billing rules beginning as far back as January 1, 2016:

  • Codes that should have been added effective January 1, 2016 - 77770, 77771, 77772
  • Codes that should have been added effective January 1, 2017 - G0491, G0500, J9034, J9301, Q0083, Q0084, Q0085, 36598, 77385, 77386, 77770, 77771, 77772, 79005, 79101, 79445, 96446, 99151, 99152, 99155, 99156, and 99157
  • Codes that should have been added effective January 1, 2018 - 00731, 00732, 00811, 00812, 00813, and 77772

In these cases, the SNF has the right to request a refund from providers and suppliers they may have paid separately due to this CMS error. The Part B provider or supplier would then be able to submit a request for payment from their MAC.

SNF billing staff should review this article for full details of this opportunity to retrieve potentially lost revenue back to 2016, and to identify two new biologic injection codes that are exempt from SNF CB effective July 1, 2018.

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