Friday, June 26, 2020

Claims Processing Guidance for 3-Day Stay and Spell-of-Illness Waivers

On June 26, the Centers for Medicare and Medicaid Services (CMS) updated SNF billing guidance related to Medicare beneficiaries receiving care when a SNF utilizes the COVID-19 public health emergency (PHE) 3-day stay and spell-of-illness waivers. The new guidance was posted in a revised MLN Matters article SE20011 under the heading “Skilled Nursing Facility (SNF) Benefit Period Waiver - Provider Information” (pages 9-13).

This section includes a summary of the waivers, examples of how beneficiaries could qualify for the qualifying hospital stay (QHS) 3-day stay waiver as well as the spell-of-illness benefit period waiver. Most importantly, CMS included detailed guidance for documentation, completing MDS assessments, and entering claims data needed in order to permit processing of claims using the waivers. CMS notes that the MACs will be required to manually process waiver claims but must “make every effort to ensure timely payment” within the 14 day payment floor. Finally, CMS provided guidance related to handling claims previously submitted that need to be addressed to bypass existing edits.

AHCA/NCAL highly recommends that providers review the guidance and share with clinical and billing staff. CMS is expected to post frequently asked questions (FAQs) associated with is updated billing guidance soon. AHCA/NCAL will notify members when the FAQs are posted.

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