SNF PDPM Claims Issue - Resolved 10/30/20

Provider/Supplier Type(s) Impacted: SNF

Reason Codes: Not applicable.

Claim Coding Impact: Not applicable.

Description of Issue: Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly.

Noridian Action Required: Noridian will provide additional updates as they are available.

Provider/Supplier Action Required:
In the interim:

  • Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims
  • Updated 5-21-2020 - Providers should not cancel and rebill. Please hold adjustments until October.
  • Providers are encouraged to submit a complete bill at the time of entry

10/30/20 - Providers can either adjust claims for correct payment or contact the Provider Contact Center to adjust claims. Noridian will adjust any Medicare Advantage (MA) claims brought to the MAC’s attention, that processed prior to October 1, 2020, so that the prior days count is corrected to exclude the MA days.

Proposed Resolution/Solution: CMS expects the issue to be corrected in October.

10/30/20 - Please see Med Learn Matters article MM11727 for an explanation of the updates made on 10/05/20.

Date Reported: 02/28/20

Date Resolved: 10/30/20

Last Updated Thu, 05 Nov 2020 17:56:38 +0000