Skilled Nursing Facility (SNF) Patient Driven Payment Model

120 - Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) (Rev. 4409, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19) SNFs billing on Type of Bill (TOB) 21X and rural hospital (non-CAH) swing-bed providers billing on TOB 18X (subject to SNF PPS), will be subject to these requirements. Currently, under the SNF PPS, revenue code 0022 indicates that this claim is being paid under the SNF PPS. This revenue code can appear on a claim as often as necessary to indicate different Health Insurance Prospective Payment System (HIPPS) Rate Code(s) and assessment periods. The HCPCS/Rates field must contain a 5-digit “HIPPS Code”. Under the previous case-mix classification model, the Resource Utilization Groups, version 4 (RUG-IV), the first three positions of the code contained the RUG group, and the last two positions of the code contained a 2-digit assessment indicator (AI) code.