(Medicare Claims Processing Manual Crosswalk)

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 Description6 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 Physicians 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 Beneficiarys 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 Physicians 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