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Updates to Current Inpatient Claim Edits

This instruction updates current Skilled Nursing Facility (SNF) edits to bypass services related to an emergency room encounter and there is also a 250 revenue code present on the same claim, which is currently being done by the Medicare Administrative Contractor (MAC). This CR also makes updates to certain duplicate edits since the implementation of SNF Patient Driven Payment Model (PDPM.). Finally, this CR will update an Inpatient Prospective Payment System (IPPS) edit to allow MACs to bypass after claims review.

Download the Guidance Document

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: May 17, 2022

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.