100-04 Medicare Claims Processing Manual: Chapter 6 Crosswalk
us-cms-medicare-manuals-pub-100-04-clm104c06crosswalk100-04 Medicare Claims Processing Manual: Chapter 6 CrosswalkGuidance
Medicare Claims Processing Manual Chapter 6 - SNF Inpatient Part A Billing Crosswalk New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 10 SNF-515 A-02-016 CR-1666 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) and Consolidated Billing Overview 6 10.1 Consolidated Billing Requirement for SNFs 6 10.2 Types of Facilities Subject to the Consolidated Billing Requirement for SNFs 6 10.3 Types of Services Subject to the Consolidated Billing Requirement for SNFs 6 20 SNF-515 Services Included in Part A PPS Payment Not Billable Separately by the SNF 6 20.1 SNF-516 Services Beyond the Scope of the Part A SNF Benefit 6 20.1.1 SNF-516, SNF-516.1 Physician’s Services and Other Professional Services Excluded From Part A PPS Payment and the Consolidated Billing Requirement 6 20.1.1.1 Correct Place of Service (POS) Code for SNF Claims 6 20.1.2 SNF-516.3 Other Excluded Services Beyond the Scope of a SNF Part A Benefit
New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 20.1.2.1 SNF-516.3 Cardiac Catheterization 6 20.1.2.2 SNF-516.3 Computerized Axial Tomography (CT) Scans 6 20.1.2.3 SNF-516.3 Magnetic Resonance Imaging (MRIs) 6 20.1.2.4 SNF-516.3 Outpatient Surgery and Related Procedures– Inclusion 6 20.1.2.5 SNF-516.3 Radiation Therapy 6 20.1.2.6 SNF-516.3 Angiography, Lymphatic, Venous, and Related Procedures 6 20.1.2.7 SNF-516.3 Emergency Services 6 20.2 SNF-516 Services Excluded from Part A PPS Payment and the Consolidated Billing Requirement on the Basis of Beneficiary Characteristics and Election 6 20.2.1 Dialysis and Dialysis Related Services to a Beneficiary With ESRD 6 20.2.1.1 SNF-516.6 A-02-118 ESRD Services 6 20.2.1.2 Coding Applicable to Services Provided in a Renal Dialysis Facility (RDF) 6 20.2.1.3 Coding Applicable to Services Provided in a RDF or SNF as Home
New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 20.2.1.4 SNF-543 Coding Applicable to EPO Services 6 20.2.2 SNF-515.1 Hospice Care for a Beneficiary’s Terminal Illness 6 20.3 SNF-515.1 Other Services Excluded from SNF PPS and Consolidated Billing 6 20.3.1 SNF-516.2 Ambulance Services 6 20.3.2 SNF-516.4 Chemotherapy, Chemotherapy Administration, and Radioisotope Services 6 20.3.3 SNF-516.5 Certain Customized Prosthetic Devices 6 20.4 SNF-515.7 Screening and Preventive Services 6 30 SNF-515.3 A-01-056, A-02-016 CR-1666 Billing SNF PPS Services 6 30.1 Health Insurance Prospective Payment System (HIPPS) Rate Code 6 30.2 A-01-56, A-01-124 CR-1655 Special Billing Requirements Where a Single OMRA, SCSA, or SCPA ARD is Set Within the Window of a Medicare-Required Assessment 6 30.3 Special Billing Requirements Where There are Multiple Assessments (i.e., OMRA, SCSA, or SCPA) Within the Window of a Medicare-Required Assessment
New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 30.4 Coding PPS Bills for Ancillary Services 6 30.5 SNF-515.5 A-00-46, A-01-121 CR-1224 Adjustment to Health Insurance Prospective Payment System (HIPPS) Codes Resulting From Long Term Care Resident Assessment Instrument (RAI) Corrections 6 30.5.1 Adjustment Requests 6 40 SNF-517, SNF-561 Special Inpatient Billing Instructions 6 40.1 A3-3603.2 SNF-517.13 Submit Bills in Sequence 6 40.2 A3-3603.2 SNF-517.14 Reprocessing Inpatient Bills in Sequence 6 40.3 SNF-515.4, SNF-515.4 Determining Part A Admission Date, Discharge Date, and Utilization Days 6 40.3.1 Date of Admission 6 40.3.2 A3-3630 SNF-517.5 Patient Readmitted Within 30 Days After Discharge 6 40.3.3 A3-3610.5, A3-3620 SNF-517.6 Same Day Transfer 6 40.3.4 SNF-517.6, SNF-515.4 (transmittal 368) Day of Discharge, Death, or Leave of Absence
New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 40.3.5 A3-3103.4 SNF-517.6.B Determine Utilization on Day of Discharge, Death, or Day Beginning a Leave of Absence 6 40.3.5.1 SNF-517.2 Day of Discharge or Death Is the Day Following the Close of the Accounting Year 6 40.3.5.2 SNF-517.4 Leave of Absence 6 40.4 SNF-517.1 Accommodation Charges Incurred in Different Accounting Years 6 40.5 SNF-5l7.7 Billing Procedures for Periodic Interim Payment (PIP) Method of Payment 6 40.6 SNF-517.9 Total and Noncovered Charges 6 40.6.1 SNF-517.10 Services in Excess of Covered Services 6 40.6.2 SNF-517.11 Showing Discounted Charges 6 40.6.3 SNF-517.12 Reporting Accommodations on the Claim 6 40.6.4 A3-3620 SNF-525 Bills with Covered and Noncovered Days 6 40.6.5 SNF-517.8 Notification of Limitation on Liability Decision
New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 40.7 A3-3624, A3-3630 A3-3630.1, A3-3630.4, A3-3620, A3-3624.B SNF-517.3, SNF-526, SNF-527, SNF-527.1 HO-411 Other Billing Situations 6 50 AB-01-131 SNF Payment Bans, or Denial of Payment for New Admissions (DPNA) 6 50.1 AB-01-131 Effect on Utilization Days and Benefit Period 6 50.2 AB-01-131 Billing When Ban on Payment Is In Effect 6 50.2.1 AB-01-131 Tracking Days to Calculate the Part A Benefit Period 6 50.2.2 AB-01-131 Provider Liability Billing Instructions 6 50.2.3 AB-01-131 Beneficiary Liability Billing Instructions 6 50.2.4 AB-01-131 Part B Billing 6 50.3 AB-01-131 Sanctions Lifted: Procedures for Beneficiaries Admitted During the Sanction Period 6 50.3.1 AB-01-131 Tracking the Benefit Period 6 50.3.2 AB-01-131 Determining Whether Transfer Requirements Have Been Met
New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 50.4 AB-01-131 Conducting Resident Assessments 6 50.5 AB-01-131 Physician Certification 6 50.6 AB-01-131 Intermediary Responsibilities 6 50.7 AB-01-131 Retroactive Removal of Sanctions 6 60 A3-3600.5 SNF-520 Billing Procedures for a Provider With Multiple Provider Numbers or a Change in Provider Number 6 70 SNF-518 Billing for Services After Termination, Expiration, or Cancellation of Provider Agreement, or After Payment is Denied for New Admissions 6 70.1 SNF-518.1 General Rules 6 70.2 SNF-518.2 Billing for Covered Services 6 70.3 SNF-518.3 Part B Billing 6 80 SNF-502 updated with transmittal 368, SNF-275 Billing Related to Physician’s Services 6 80.1 SNF-507 Reassignment Limitations 6 80.2 SNF-508, SNF-510 Payment to Employer of Physician
New Chap. New Sect. Int. Pub. 13 Carrier Pub. 14 SNF Pub. 12 PM Other Description 6 80.3 SNF-510.1 Information Necessary to Permit Payment to a Facility 6 80.4 SNF-510.2 Services Furnished Within the SNF 6 80.5 SNF-510.2 Billing Under Arrangements 6 80.6 SNF-510.3 Indirect Contractual Arrangement 6 80.7 SNF-512 Establishing That a SNF Qualifies to Receive Part B Payment on the Basis of Reassignment 6 90 SNF-500 AB-01-132 SNF Billing to HMO 6 90.1 A-01-122, A-02-009 Beneficiary Involuntarily Disenrolled from Terminated Medicare+Choice (M+C) Plans 6 100 A-02-016 Part A SNF PPS for Hospital Swing Bed Facilities 6 100.1 A-02-016 Swing Bed Services Not Included in the Part A PPS Rate
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