Reprocessing of Skilled Nursing Facility Claims

In early February, the Centers for Medicare and Medicaid Services (CMS) announced it had discovered an error in the non-labor share percentage used for calculating Skilled Nursing Facility (SNF) and Swing Bed (SB) Prospective Payment System (PPS) reimbursement for fiscal year 2011. Reports indicate that the error caused all SNF and SB claims from October 1, 2010 until now to generate slightly lower payments for RUG rates. CMS is correcting this percentage in the SNF Pricer and, upon successful implementation, contractors will begin adjusting all previously adjudicated SNF and SB PPS claims with discharge dates on or after October 1, 2010, to apply correct reimbursement. This adjustment process may take up to 8-10 weeks to finalize. According to CMS, the impact on the per-claim payment is very small.

In addition, CMS instructed contractors to suspend any newly submitted SNF and SB PPS claims, with discharge dates on or after October 1, 2010, at the contractor’s sites until the updated SNF Pricer is installed. CMS expects to complete full testing and installation by February 14, 2011.

Should you have any questions about this article or other issues relating to long term care payments, please contact Lori McLaughlin at lmclaughlin@kdlegal.com or (219) 227-6075.