Federal (United States) · Agency guidance
Chapter 6
106 sections
106 sections
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 10Skilled Nursing Facility (SNF) Prospective Payment System (PPS)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 10.1Consolidated Billing Requirement for SNFs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 10.2Types of Facilities Subject to the Consolidated Billing
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 10.3Types of Services Subject to the Consolidated Billing
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 10.4Furnishing Services that are Subject to SNF Consolidated Billing
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 10.4.1“Under Arrangements” Relationships
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 10.4.2SNF and Supplier Responsibilities
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20Services Included in Part A PPS Payment Not Billable Separately
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.1Services Beyond the Scope of the Part A SNF Benefit
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.1.1Physician’s Services and Other Professional Services Excluded
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.1.1.2Hospital’s “Facility Charge” in Connection with Clinic
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.1.2Other Excluded Services Beyond the Scope of a SNF Part A
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.1.2.1Outpatient Surgery and Related Procedures - INCLUSION
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.1.2.2Emergency Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.2Services Excluded from Part A PPS Payment and the
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.2.1Dialysis and Dialysis Related Services to a Beneficiary With
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.2.1.1ESRD Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.2.1.2Coding Applicable to Dialysis Services Provided in a Renal
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.2.2Hospice Care for a Beneficiary’s Terminal Illness
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.3Other Services Excluded from SNF PPS and Consolidated Billing
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.3.1Ambulance Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.4Screening and Preventive Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.5Therapy Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 20.6SNF CB Annual Update Process for A/B MACs (A)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 30Billing SNF PPS Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 30.1Health Insurance Prospective Payment System (HIPPS) Rate
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 30.2Coding PPS Bills for Ancillary Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 30.3Adjustment Requests
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 30.4SNF PPS Pricer Software
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 30.5Annual Updates to the SNF Pricer
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40Special Inpatient Billing Instructions
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.1Submit Bills in Sequence
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.2Reprocessing Inpatient Bills in Sequence
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3Determining Part A Admission Date, Discharge Date, and
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3.1Date of Admission
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3.2Patient Readmitted Within 30 Days After Discharge
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3.3Same Day Transfer
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3.4Situations that Require a Discharge or Leave of Absence
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3.5Determine Utilization on Day of Discharge, Death, or Day
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3.5.1Day of Discharge or Death Is the Day Following the Close of
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.3.5.2Leave of Absence
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.4Accommodation Charges Incurred in Different Accounting Years
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.5Billing Procedures for Periodic Interim Payment (PIP) Method of
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.6Total and Noncovered Charges
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.6.1Services in Excess of Covered Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.6.2Showing Discounted Charges
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.6.3Reporting Accommodations on the Claim
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.6.4Bills with Covered and Noncovered Days
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.6.5Notification of Limitation on Liability Decision
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.7Ending a Benefit Period
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.8Billing in Benefits Exhaust and No-Payment Situations
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.8.1SNF Spell of Illness Quick Reference Chart
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.8.2Billing When Qualifying Stay or Transfer Criteria are Not Met
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 40.9Other Billing Situations
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50SNF Payment Bans, or Denial of Payment for New Admissions
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.1Effect on Utilization Days and Benefit Period
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.2Billing When Ban on Payment Is In Effect
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.2.1Effect of an Appeal to a DPNA on Billing During the Period the
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.2.2Provider Liability Billing Instructions
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.2.3Beneficiary Liability Billing Instructions
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.2.4Part B Billing
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.3Sanctions Lifted: Procedures for Beneficiaries Admitted During
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.3.1Tracking the Benefit Period
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.3.2Determining Whether Transfer Requirements Have Been Met
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.4Conducting Resident Assessments
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.5Physician Certification
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.6A/B MACs (A) Responsibilities
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 50.7Retroactive Removal of Sanctions
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 60Billing Procedures for a Composite SNF or a Change in Provider
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 70Billing for Services After Termination of Provider Agreement, or
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 70.1General Rules
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 70.2Billing for Covered Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 70.3Part B Billing
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80Billing Related to Physician’s Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80.1Reassignment Limitations
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80.2Payment to Employer of Physician
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80.3Information Necessary to Permit Payment to a Facility
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80.4Services Furnished Within the SNF
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80.5Billing Under Arrangements
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80.6Indirect Contractual Arrangement
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 80.7Establishing That a SNF Qualifies to Receive Part B Payment on
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 90Medicare Advantage (MA) Beneficiaries
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 90.1Beneficiaries Disenrolled from MA Plans
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 90.2Medicare Billing Requirements for Beneficiaries Enrolled in MA
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 100Part A SNF PPS for Hospital Swing Bed Facilities
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 100.1Swing Bed Services Not Included in the Part A PPS Rate
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110A/B MAC (B)/DME MAC Claims Processing for Consolidated
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.1Correct Place of Service (POS) Code for SNF Claims
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2CWF Edits
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2.1Reject and Unsolicited Response Edits
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2.2A/B Crossover Edits
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2.3Duplicate Edits
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2.4Edit for Ambulance Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2.5Edit for Clinical Social Workers (CSWs)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2.6Edit for Therapy Services Separately Payable When Furnished
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.2.7Edit to Prevent Payment of Facility Fees for Services Billed by
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.3CWF Override Codes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.4Coding Files and Updates
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 110.4.1Annual Update Process
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 6 § 120Skilled Nursing Facility (SNF) Patient Driven Payment Model