New Skilled Nursing Facility (SNF) Health Insurance Prospective Payment System (HIPPS) Codes: Error Regarding Skilled Nursing Facility Claims Which Contain Default HIPPS Code of AAA00
When CMS (Center for Medicare & Medicaid) issued its 2012 Final SNF PPS Rule, it created the new Change of Therapy Other Medicare Required Assessment, referred to as the COT OMRA. In doing so, CMS also developed a process to allow providers to report a Resumption of Therapy OMRA following an End of Therapy (EOT) OMRA, referred to as an EOT-R OMRA. The result of the above new OMRAs meant CMS had to create several new Assessment Indicators (AIs) to identify when a COT OMRA was completed, and when an EOT OMRA was completed, accounting for both scenarios of with and without a resumption of therapy. These new AIs are described in the revised RAI Manual, Chapter 6, Section 6.4 – Relationship Between the Assessment and the Claim (pages 5-21).
CMS had to add approximately 1,500 new Health Insurance Prospective Payment System (HIPPS) codes to the Fiscal Intermediary Shared System (FISS) to account for these new AIs.
October 2011 Medicare SNF claims (21X) Type of Bill (TOB) billed with the default HIPPS code of AAA00 are being returned because the claims do not contain an occurrence code 50 with the assessment reference date.
Therefore, providers that are billing Medicare October 2011 claims that include a Change of Therapy (COT) assessment and/or an EOT-R assessment are receiving a front end edit Gen Report error
'HIPPS RATE CODE IS INVALID'.
This edit is in error since the default code does not require an occurrence code 50 and the date.
This issue is expected to be resolved by CMS by Monday, November 17th.
Providers can continue to bill Medicare as usual, and once the above issue is resolved, can bill the rejected claims containing COT and/or EOT OMRAs separately.