CMS releases updates to CR 11152 Implementation of the SNF PDPM

Nov 15, 2019
The Bottom Line

A new MLN Matters Article MM11513 on Updates to CR 11152 Implementation of the SNF PDPM is available. The article releases information that is effectice April 2020. The upate concerns Veterans Administration demonstration claims under PDPM. MLN states:

SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X (subject to SNF PPS) will be subject to these requirements. CR 11152 (See the related MLN Matters article at MLN/MLNMattersArticles/Downloads/MM11152.pdf.) erroneously omitted the VA from the CR. CR 11513 adds changes to cover the VA. There are no policy changes in CR 11513.

MACs will bypass the edit that requires an occurrence code 50 for each 0022 revenue code on TOB 021x for Demo 31 (VA demonstration) claims for all dates of service.

MACs will update the edit that ensures a default Health Insurance Prospective Payment System (HIPPS) code on VA demonstration claims of ZZZZZ, effective October 1, 2019. The MACs will
ber 1, 2019. MACs will also discontinue the workaround currently in place for this edit effective with the implementation of CR 11513.


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