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News And Events
CMS is aware of a systems problem that is delaying payment
of some inpatient and Skilled Nursing Facility (SNF) claims processed beginning
April 2. The systems issue has been fixed and payments for these claims will be
made soon. Providers that believe their claims have been delayed should check
the claims status after May 15. CMS apologizes for the inconvenience.
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Automatic Reprocessing of Specific Long-Term Care Hospital
Short Stay Outlier Claims
A payment calculation problem affecting some Long-Term Care Hospital (LTCH) short stay outlier (SSO) claims was discovered in the FY2012 LTCH Pricer. CMS has
corrected the problem and reissued a revised Pricer on Tue Jan 17, 2012. Your
claims administration contractor will automatically reprocess any affected
FY2012 LTCH claims that were processed before the corrected Pricer was
installed.
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corrected the problem and reissued a revised Pricer on Tue Jan 17, 2012. Your
claims administration contractor will automatically reprocess any affected
FY2012 LTCH claims that were processed before the corrected Pricer was
installed.
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Claims Processing Issue Related to Part B Services for
Skilled Nursing Facility Patients
Because of a claims processing problem, Part B Services related to ambulance code A0425 for Skilled Nursing Facility (SNF) patients submitted to Medicare with dates of service on or after Sun Jan 1 through Wed Feb 22, 2012, may have been
erroneously denied by Medicare¡¯s claims processing system. In other instances,
the claims processing system may have paid and then identified a Medicare
¡°overpayment¡± on these claims in error. The situation was corrected as of Wed
Feb 22.
Skilled Nursing Facility Patients
Because of a claims processing problem, Part B Services related to ambulance code A0425 for Skilled Nursing Facility (SNF) patients submitted to Medicare with dates of service on or after Sun Jan 1 through Wed Feb 22, 2012, may have been
erroneously denied by Medicare¡¯s claims processing system. In other instances,
the claims processing system may have paid and then identified a Medicare
¡°overpayment¡± on these claims in error. The situation was corrected as of Wed
Feb 22.
CMS is working with its Medicare Administrative Contractors (MACs) to identify all claims that were denied in error as well as any erroneously-identified
overpayments that generated demand letters, so that appropriate claim
adjustments can be made. Your MAC will advise you through its website and
listserv messages when it expects to complete this process so that you can
anticipate when your claims (along with any notifications for payment recovery)
will be adjusted. We thank you for your patience and we apologize for any
inconvenience.
If you have any additional questions please contact your Medicare Carrier or
Medicare Administrative Contractor.
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Skilled Nursing Facility FY2012 PC Pricer Revised [¡è]
The Skilled Nursing Facility (SNF) FY2012 PC Pricer has been revised to correct an intermittent problem, and has been updated on the CMS website. If you use the FY2012 SNF PC Pricer, please visit http://www.CMS.gov/PCPricer/04_SNF.asp and download the revised file.
¨ª Additional material related to Skilled Nursing Facilities in today¡¯s e-News¡œ [previous]
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Temporary Workaround for the Assessment Reference Date Reason Code 31742 for Skilled Nursing Facility and Swing Bed Claims
CMS has developed a workaround for Skilled Nursing Facility (SNF) and Swing Bed (SB) claims incorrectly returned to the provider for assessment reference date (ARD) reason code 31742 to allow these claims to process. Providers with claims
returned due to the incorrect application of this reason code should send them
back to Medicare for processing. Be sure to bill the correct ARDs with
occurrence code 50 prior to sending these claims to Medicare for processing.
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