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Client Alert: CMS Claims Processing Problems Delaying SNF Payments

The Centers for Medicare & Medicaid Services (CMS) has identified a claim-processing problem impacting Skilled Nursing Facility type of bills 18x and 21x containing Healthcare Common Procedure Coding System (HCPCS) code AAAxx and Revenue Code 0022. In addition, CMS is also working on another claims processing issue that involves new HIPPS codes effective 10/1/11 that result from the implementation of the Change of Therapy Other Medicare Required Assessments (COT OMRAs). CMS seems to be holding or rejecting post October 1 related claims presently.

AHCA has been in regular contact with CMS on these issues. A clarification on these issues from CMS is expected shortly. For planning purposes, claim payments are likely to be delayed through November. Look for further AHCA updates on this issue in Capitol Connection next week.