Program_Memos / 2000 / B-00-67

Why This Topic Matters

The memorandum affects how SNF resident services are billed, which claims may be paid separately, and what edits contractors use to detect billing mismatches. It is important for avoiding rejections, duplicate billing issues, and incorrect payment processing for SNF stays.

Article Sections

1. Program Memorandum and Background

   Introduces the memorandum, its subject, and the general Medicare consolidated billing framework for SNF residents. It also provides the background and implementation context for the policy.

2. New Procedures and Determining the End of a SNF Stay

   Describes operational updates effective in 2001 and outlines when SNF resident status ends for consolidated billing purposes. It also identifies the facility types included or excluded from the policy.

3. Types of Services Included and Excluded from Consolidated Billing

   Summarizes the broad categories of services subject to consolidated billing and the types of services carved out from that framework. It also addresses ambulance and managed care-related considerations.

4. Claims Processing Instructions, Carrier and CWF Edits

   Covers claim form and electronic record requirements, processing edits, and general carrier and CWF instructions. It includes guidance on facility identifiers, review edits, and adjustment messages.

5. Use of the PC/TC Indicators to Identify Physician's Services

   Explains how carrier processing uses professional and technical component indicators for physician-related services in the SNF setting. It includes general processing categories and associated claim handling.

6. HCPCS Codes to Identify Physical, Occupational and Speech Language Therapy Services and Audiologic Function Tests

   Lists therapy and audiologic function testing service codes addressed by the memorandum and describes how they are handled in consolidated billing. It also references associated remittance and beneficiary notice messaging.

7. Ambulance Claims

   Addresses ambulance claims and the circumstances under which they are handled within or outside consolidated billing. It also notes claim-processing outcomes and related messaging.

8. Specific Drugs, Services, and Supplies to be Excluded from CB

   Presents categories of drug, service, and supply codes identified as excluded from consolidated billing. Subsections organize these exclusions by service category and billing context.

9. Chemotherapy Drugs

   Lists chemotherapy drug codes that are addressed as part of the exclusion categories. The section is part of the broader excluded-drugs discussion.

10. Chemotherapy Administration Services

    Lists codes for administration-related services within the exclusion categories. It is grouped with other excluded drug and procedure categories.

11. Radioisotope Services

    Lists codes for radioisotope-related services included in the exclusion discussion. This subsection is part of the broader services and supplies exclusions.

12. Customized Prosthetic Devices

    Lists codes for customized prosthetic devices identified in the exclusion list. It appears as one of the specific categories carved out from consolidated billing.

13. Codes for Emergency Services Excluded from CB

    Covers emergency and outpatient hospital services that are treated differently under consolidated billing. The section is subdivided by service category and includes claim-processing conditions.

14. CT Scans

    Lists computed tomography service codes included in the emergency-services exclusion discussion. These are organized as a subcategory of the outpatient services section.

15. Cardiac Catheterization

    Lists cardiac catheterization service codes addressed in the emergency-services exclusion section. It is one of several outpatient procedure subcategories.

16. MRI

    Lists magnetic resonance imaging service codes included in the outpatient emergency-services discussion. This subsection is part of the broader exclusion framework.

17. Radiation Therapy

    Lists radiation therapy codes addressed under the outpatient services exclusion area. It forms another subcategory within the emergency-services section.

18. Angiography

    Lists angiography-related codes included in the outpatient services discussion. It is presented as a distinct procedure category within the broader section.

19. Outpatient Surgery

    Lists outpatient surgery-related codes and notes which services are treated differently under consolidated billing. It also includes claim-processing checks tied to place of service.

20. Erythropoietin (EPO) Services

    Describes the EPO-related exclusions and associated code groupings. This section is part of the broader list of services and supplies excluded from consolidated billing.

21. Dialysis

    Addresses dialysis-related services, supplies, and diagnosis-code requirements in the SNF setting. It is included among the explicit exclusions from consolidated billing.

22. CWF Edits

    Discusses claim history interactions, auto-cancel responses, and utilization edits involving SNF inpatient and Part B claims. It also outlines general contractor resolution procedures and managed care exceptions.

23. Notification

    Notes provider notification expectations and the memorandum's implementation, effective, and discard dates. This section closes the main memorandum text.

24. Attachment

    Introduces an attachment on carrier edits for SNF consolidated billing. It explains the purpose of the edit logic and the related system considerations.

25. Carrier Edits for SNF Consolidated Billing

    Provides detailed edit logic and operational handling for SNF consolidated billing in CWF and carrier systems. It includes utilization and consistency edits, duplicate claim logic, and processing exceptions.