Medicare Part A UB-04 Claim Form Changes:
SNF Open Door Forum Billing Clarifications For CR 7339
The skilled nursing facility (“SNF”) Open Door Forum reviewed various billing issues included in Change Request 7339. The date of implementation has been moved to August 1, 2011. Our Director of Clinical Services has been monitoring this issue closely since April 2011. We have been working closely with our clients on how to address these issues in CarePoint. After a number of clarifications, CMS has settled on the two changes detailed below. Specifically .....
1. The “Days of Treatment” by discipline, otherwise defined as visits, will take the place of units on the UB-04 claim form.
On a Medicare Part A UB-04 claim form, field 46 used to have the total units of each discipline for the month. Now, CMS wants the total number of calendar days in that field. This is to be listed per discipline and does not relate to BID treatments or sessions.
For example, if physical therapy treated a patient on 20 different days in a given month, then 20 would be the number of service units in field 46 on the UB-04 claim form. If occupational therapy treated the patient on 15 different days, then enter 15 service units in field 46. The same would apply to speech therapy. Each discipline uses the same Revenue Codes as before.
2. Place the "End of Therapy" date in the Occurrence Code 16 field which is the day after all disciplines are complete.
Occurrence Code 16 is used only when an End of Therapy (“EOT”) OMRA is completed. The EOT OMRA is done the day after the last therapy has ended. The MDS coordinator has 3 days to complete the EOT OMRA but Occurrence Code 16 would indicate the actual last date of a therapy RUG’s level.
3. Additional Information
CarePoint therapy management software works with more than 30 SNF billing software systems. We have surveyed several SNF billing software companies that accept our Billing Interface file. At present, these companies summarize units from our Billing Interface file for inclusion on the UB-04 claim form.
Feedback we have received from these companies indicates that they plan to address this issue from their end when creating the UB-04 claim form. We suggest you check with the billing managers at your facility to verify that their SNF billing software system will be address this issue by 8/1/2011.
The official instruction, CR 7339 issued to your FI or A/B MAC regarding this change may be viewed at http://www.cms.gov/transmittals/downloads/R2245CP.pdf on the CMS website.
Contact your FI or A/B MAC at their toll-free number with any questions, which may be found at http://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zipon the CMS website.