Hospital and Skilled Nursing Facility (SNF) Verification of Prior

10.5 - Hospital and Skilled Nursing Facility (SNF) Verification of Prior Hospital Stay Information for Determining Deductible and Benefit Period Status (Rev. 3441, Issued: 01-15-16, Effective; 12-31-13; ASC X12: 01-01-12, MAC Implementation: 02-16-16; ASC X12: 02-16-16) If it has been determined that Medicare is the primary payer, the hospital or SNF must determine if the patient has been an inpatient in any hospital or SNF, including swing bed stays, during the prior 60 days. If so, the hospital or SNF must determine the admission and discharge dates and the number of days of hospitalization or skilled nursing (as applicable) the patient used in the current benefit period. The admission and discharge dates must be reported on the claim, and the number of days of hospitalization or skilled nursing (as applicable) must be used to calculate the hospital insurance copayment and the number of days remaining in the benefit period. If the patient indicates he/she was not an inpatient within the last 60 days, the hospital applies the inpatient deductible to the current stay if it is a covered hospital admission. The A/B MAC (A) determines the accuracy of the claim data after receipt of the claim. The remittance advice received from the A/B MAC (A) reflects the amount of deductible (hospital claims) and coinsurance (hospital and SNF claims) applied. If this amount is different from what was billed, the hospital/SNF must correct the records accordingly.