Cut and pasted from UGS's June 2003 Medicare Memo- which is a reprint of a CMS letter dated 6-9-03. Another reason I would not follow the advice being given in previous emails.
Theresa Lang
Specialized Medical Services, Inc.
Milwaukee WI
SNF Benefits Exhausted
Reminder: Skilled Nursing Facility (SNF) and Hospital Swing Bed Providers Are To Submit a
Claim Whenever the Beneficiary Ceases to Require a Skilled Level of Care
CMS Letter dated June 9, 2003
It has come to our attention that once a beneficiary has exhausted his/her benefits, many SNFs are not
submitting a bill to indicate when the beneficiary ceases to need skilled care. This memorandum serves to
remind you that a bill is required whenever the beneficiary ceases to need skilled care, whether or not said
beneficiary has any Medicare benefits remaining. This is necessary for the Common Working File (CWF) to
correctly calculate the spell of illness.
Instructions to this effect are in the
Medicare SNF Manual in the second paragraph of §527.Providers are to show the end of the need for skilled care by using occurrence code (OC) 22, Date Active
Care Ended, in the appropriate form locator of a non-payment inpatient SNF bill, as follows:
Type of Bill
210;Date of Admission
the date the beneficiary entered the SNF;Patient Status
30, still patient;OC A3, B3, or C3
the date benefits were exhausted, which may or may not havealready occurred and been reported. If benefits are not exhausted,
this OC will not appear on the bill;
and/or:OC 22
the date the beneficiary ceased to need skilled care.-----Original Message-----Theresa,
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Saturday, January 17, 2004 12:04 AM
To: [EMAIL PROTECTED]
Subject: Benefit period
this is why residents receive new benefit periods. I have talked to two billers in CA and they both say they were told by BX and UGS to use 22. And I see that is the same information I received. Do you have an e-mail address for the center for medicare management?
D
Delores L. Galias, RN, RHIT
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