SNF CB Annual Update Process for A/B MACs (A)

20.6 - SNF CB Annual Update Process for A/B MACs (A) (Rev. 3230, Issued: 04-03-15, Effective: 06-15-15, Implementation: 06-15-15) Barring any delay in the Medicare Physician Fee Schedule, CMS will provide the new Annual Update code file to CWF by November 1. Should this date change, CWF will be notified through the appropriate mechanism. All future updates will be submitted via a Recurring Update Notification form. These Recurring Update Notifications also describe how the changes will be implemented. The CWF contractor shall compare the new code list for Major Categories I through V to the codes in the current edits. Codes that appear on the new list, but not in the current edit, shall be added to the edit. CMS will make a determination as to which codes should be deleted from which edits. This mechanism will allow for any changes in professional component/technical component designations to be correctly coded for edits and for deleted codes and codes no longer valid for Medicare purposes as of the end of the calendar year, to continue to pay correctly for prior dates of service. CMS will respond to the list provided by the CWF contractor and provide the determination on the codes to the CWF contractor. The CWF contractor will delete codes from the edits per the CMS determination. A/B MACs (A), a term used to indicate both Part A and Part B institutional services, shall continue to respond to rejects and unsolicited responses received from CWF per current methodology. A/B MACs (A) shall reopen and reprocess any claims brought to their attention for services that prior to this update were mistakenly considered to be subject to consolidated billing and therefore, not separately payable. A/B MACs (A) need not search claims history to identify these claims. Prior to January 1 of each year, a new code file will be posted to the CMS Web site at: http://www.cms.hhs.gov/SNFConsolidatedBilling/. Should this date change, A/B MACs (A) will be notified through the appropriate mechanism. Coding changes throughout the year may also be made as necessary through a quarterly update process. As soon as the new code file is posted to the CMS Web site, through their Web sites and list serves, A/B MACs (A) shall notify providers of the availability of the new file.