Program_Memos / 2002 / AB-02-023

Why This Topic Matters

The memorandum affects how Medicare systems detect and respond to claims that may be included in SNF Part A payment, how certain services are excluded or separately payable, and how related adjustments and notices are handled.

Article Sections

1. I. Edits for CWF and Intermediaries

   Overview of the claims-processing edits, duplicate-payment checks, intermediary actions, and general system update requirements discussed in the memorandum.

2. A. General

   Broad description of the consolidated billing context, the role of CWF, and the types of claim comparisons performed.

3. B. Standard Systems (SSs) Edits

   System-edit guidance covering claim completeness checks, reporting requirements, and general handling of services subject to consolidated billing.

4. C. Specific Edits

   Detailed categories of edit scenarios for inpatient SNF claims versus Part B therapy and non-therapy claims, including response and follow-up processing.

5. II. Tables and Reference Material

   Reference tables listing service categories, revenue code groupings, and code sets used for SNF consolidated billing processing.

6. A. Tables

   Code tables and supporting reference material organized by service category and billing circumstance.

7. 1. Therapy Revenue and HCPCS Codes

   Therapy-related revenue code categories and the associated outpatient rehabilitation code list referenced for billing and processing.

8. 2. Ambulance Claims

   Ambulance-related billing references, including the claim types and code-set groupings used in the memorandum.

9. 3. Services Excluded from Consolidated Billing

   Major excluded-service categories identified for separate Medicare payment consideration, organized by treatment or device type.

10. 4. Emergency and Intensive Services Excluded from Consolidated Billing

    Hospital outpatient and CAH service categories that may be paid separately under the memorandum’s framework, grouped by procedure family.

11. 5. EPO Services

    Reference to EPO-related services and the billing identifiers associated with them.

12. 6. Preventive and Screening Service

    Preventive and screening service categories, related administration codes, and associated billing references.

13. 7. Revenue Codes Requiring HCPCS Codes on Bill Types 22X and 23X

    Revenue code families that require HCPCS reporting on specified bill types, presented as a billing reference table.