Billing and Processing Issues - P&NP Computer

Billing Issues1 February 2001 Billing and Processing IssuesIdentified Billing Errors - Provider Education NeedsModifiers New Additions and Appropriate UseBilling for 5 Day PresumptionSpecial Billing Situations:Leave of AbsenceHMOD emand BillsAdjustmentsIdentified Processing ProblemsBilling Issues2 February 2001 Identified Billing ProblemsMedical review workgroup discussions identified frequent Billing errors in SNFPPS claim submissions. These errors are common across the country and speakto the need for additional provider Reference Date (ARD)The ARD marks the end of the look back period. It must be set within thewindow of days allowed by the Medicare MDS assessment schedule. All medicaldata scored on the MDS is based on this date. An inaccurate date might resultsin an inaccurate RUG III score for Medicare Billing . It is a requirement of theprogram that it be reported correctly on the claim. Failure to do so may result inclaim denials (on prepay review) or the cancel of claim payment (on a post payreview.)

Billing Issues 5 February 2001 DESCRIPTION OF ASSESSMENT MODIFIER CODE Significant Correction Of Prior Full Assessment Off-cycle Significant Correction …

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