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Advocacy, Policy & Government » Nursing Homes » Payment & Financing

Consolidated Billing

Note to Users: In December 2005, CMS redesigned its Web site and changed many links to information on nursing home regulations, survey and certification and other aging services topics. We are working with CMS to locate materials on their new Web site and correct any broken links you may encounter. If you need information immediately, contact Evvie Munley.

CMS Clarifies Inpatient Part A Billing for No-Payment Claims
Posted: Mar. 24, 2008
A new article from the Centers for Medicare and Medicaid Services (CMS) explains the circumstances under which a skilled nursing facility must submit a no-pay bill. Facilities must submit a bill for a beneficiary who has started a spell of illness under the Part A benefit for every month of the related stay even though no benefits may be payable. In addition, facilities must submit no-payment bills for beneficiaries who have previously received Medicare-covered skilled care and subsequently dropped to a non-covered level of service but continue to reside in a Medicare-certified area of the facility. The CMS article reflects no changes in existing policy, but simply clarifies Chapter 6 of the Medicare Claims Processing Manual, SNF Inpatient Part A Billing More detailed information on key points of no-pay billing.

Quarterly Update to 2007 Annual Update of HCPCS Codes Used for SNF Consolidated Billing
Posted: Feb. 21, 2007
CMS quarterly updates the lists of Healthcare Common Procedure Coding System (HCPCS) codes for both Fiscal Intermediaries and carriers/DMERCs that are subject to the consolidated billing provision of the SNF prospective Payment System (PPS). Three HCPCS chemotherapy administration-related codes (96521, 96522 and 96523), that are subject to the consolidated billing provision of the SNF PPS were included in the January 2007 update to the carrier file, but not in the FI file. CR 5502 updates and adds these three codes to the FI file. If you need information immediately, contact Iara Woody.

CMS Proposes No Rate Increase for Long-Term Care Hospitals
Posted: January 20, 2006
A CMS fact sheet on the proposed rule for FY2007 Medicare payments to long-term care hospitals, defined as hospitals that have average Medicare inpatient lengths of stay longer than 25 days.

SNF Consolidated Billing Payment Information Revised on the CMS Website
Posted: January 20, 2006
SNF CB payment information for Carriers and Fiscal Intermediaries (FI) is now available. The revised pages include SNF CB HCPCS files, file explanations, and annual updates which are now designated specifically for Carriers and FIs. The SNF CB overview has related links to SNF CB background information and to the Medicare Learning Network (Medlearn).

New Address for the 2006 SNF CB Update File
The web site address for the "2006 Skilled Nursing Facility (SNF) Consolidated Billing (CB) Annual Update File for Services Billed to Fiscal Intermediaries (FI)" has changed. CMS is currently working on the restoration of prior year's SNF CB updates for services billed to the FI and will post them at this site as soon as possible.

2005 Annual Update of Excluded Codes
This is a complete list of HCPCS codes that are excluded from SNF CB for claims submitted to Fiscal Intermediaries for payment. Minor Surgery and Part B therapy inclusions are also included with this file.

Last Updated : 3/25/2008 9:51:55 AM

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