RESOLVED: The SNF PDPM Pricing Is Still an Ongoing Issue


Resolved — SNF PDPM Pricing

Current Status

Date

 

Resolved

May 4, 2021

Status: Change Request (CR) 11992 implemented changes to the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), specifically changes required for the PDPM. Prior to CR 11992, claims may have paid incorrectly or rejected in error. Updates to SNF Patient Driven Payment Model (PDPM) Claims became effective April 1, 2021.  Palmetto GBA implemented CR 11992 on April 5, 2021. Further billing information is available in MLN Matters® MM11992.

Palmetto and CMS are aware of the following outstanding issues regarding SNF PDPM claims. The volume of claims impacted by these issues should be minimal:

  • SNF PDPM claims with From dates in FY 2020 and a 10/01/2020 discharge date are pricing incorrectly
  • Adjustments to SNF PDPM claims where the cost report days are changed are pricing incorrectly

Provider Action: Providers may adjust or resubmit any claims not related to these outstanding issues. If providers feel claims still processed incorrectly, please contact us and provide examples for research.

Initial

January 7, 2021

Status: CMS is aware of this issue. A fix is scheduled to be implemented into production in April 2021.

Provider Action: There is no provider action required.

Identified Date

December 28, 2020

Issue

The SNF PDPM pricing is still an ongoing issue. The PRICER is not counting days correctly causing the per diem to be off and claims to incorrectly pay.


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Last Updated: 05/06/2021