CMS reimbursements delayed under new skilled nursing facility payment model

Kelly Gooch - Print  | 

CMS is delaying skilled nursing facility claims as it implements a new payment model for those facilities, an agency spokesperson confirmed.

The new CMS case-mix classification system, the Patient Driven Payment Model, took effect Oct. 1. The system aims to move Medicare payments for skilled nursing facilities from volume to value and is used for classifying patients in a Medicare Part A covered stay.

While testing to ensure accurate and timely payments for claims submitted under the new model, CMS held up 2,500 skilled nursing facility claims, spokesperson William C.F. Polglase told Becker's Hospital Review via email.

The payment delays affect claims for some inpatient and swing-bed services provided Oct. 1 or later.

Claims with single Health Insurance Prospective Payment System codes were delayed but are now being released for payment, Mr. Polglase said. The remaining claims are expected to be released in late November.

CMS said it is automatically reprocessing some skilled nursing facility inpatient services and swing-bed services claims it underpaid for dates of service in October with a single line item, single Health Insurance Prospective Payment System code.


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