Patient-Driven Payment Model (PDPM)

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SNF Claims Incorrectly Canceled (3/20)

Posted By: CMS
Post Date: 03/23/2020

From January 26 through February 16, 2020, a software issue caused Skilled Nursing Facility (SNF) claims to be incorrectly cancelled with a message that there was no three day qualifying hospital stay. This issue is corrected. If your claims were incorrectly cancelled, re-bill them in sequential order to receive payment.


·         Claims need to process in date of service order for each stay for the Variable Per Diem (VPD) to calculate correctly

·         Submit claims in sequence and wait at least 2 weeks before billing subsequent claims

·         Some of the affected claims with older dates of service will require a timely filing exception; enter “Resubmission due to non-qualifying stay” in the remarks field

·         This issue was not caused by the recent implementation of the SNF Patient Driven Payment Model

·         Contact your MAC to receive the Medicare Beneficiary Identifier (MBI) for deceased beneficiaries

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