Other Billing Situations

40.9 - Other Billing Situations (Rev. 10880, Issued: 08-06-21, Effective: 11-08-21, Implementation: 11-08-21) A. Demand Bills Where the SNF believes that a covered level of care has ended but the beneficiary disagrees, they report occurrence code 21 (UR notice received) or 22 (date active care ended) as applicable and condition code 20 indicating the beneficiary believes the services are covered beyond the occurrence date. See the Medicare Claims Processing Manual, Chapter 1, “General Billing Requirements,” §60.3, for instructions on advance beneficiary notices and demand bills. Refer to the Medicare Claims Processing Manual, Chapter 25 for further information about billing. B. Request for Denial Notice for Other Insurer The SNFs complete a noncovered bill and enter condition code 21 to indicate a request for a Medicare denial notice. Refer to Chapter 25 further information about billing. C. Another Insurer is Primary to Medicare See the Medicare Secondary Payer (MSP) Manual, Chapter 3, “MSP Provider Billing Requirements” and Chapter 5, “Contractor Prepayment Processing Requirements,” for submitting claims for secondary benefits to Medicare. Refer to the Medicare Claims Processing Manual, Chapter 25 for further information about billing. D. Special MSN Messages The Medicare Prescription Drug Improvement and Modernization Act of 2003 requires that Medicare Summary Notices (including SNF claims for post-hospital extended care services provided under Part A) report the number of covered days remaining in the given spell of illness. This requirement became effective July 6, 2004. E. Interrupted Stay Refer to the Medicare Claims Processing Manual, Chapter 6, “Interrupted Stay Policy,” §120.2, for information about billing when a patient returns to a covered level of care after an interrupted stay.