Tuesday, July 28, 2020

CMS SNF PDPM Interrupted Stay Claim Issue Workaround Announcement


Last week the Centers for Medicare and Medicaid Services (CMS) announced that a new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). CMS notes that if a SNF billed the interrupted stay correctly, and the claim is rejected, the SNF can work-around the edit by modifying the billing so the claim spans past the last day of the interrupted stay. This can be accomplished in two ways:
  • Bill two months at a time, or
  • Bill a month plus the days in the following month that span the interrupted stay plus 1 day
Adjusting the statement covered from and through dates to encompass the entire interrupted stay will allow the claim to process and pay correctly. Medicare Administrative Contractors will finalize any suspended claims that meet the criteria, so providers can make corrections and resubmit the claim.

SNF providers may hear from the hospital where the beneficiary went during the interrupted stay because this issue also is causing problems with their claims. If the MAC rejected an inpatient hospital claim, CMS is directing the hospital to ask the SNF to modify their claim. Please note, until October 5, a SNF cannot submit an adjustment to a paid claim; they must cancel the paid claim and all subsequent claims in the same stay and resubmit them in sequential order. CMS indicated that they will correct the system error in the future.

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