Bill Review Requirements

6.1.3 - Bill Review Requirements (Rev. 924; Issued: 11-15-19; Effective: 10-01-19; Implementation: 12-17-19) Medicare contractors must conduct review of SNF PPS claims in accordance with these instructions and all applicable Pub. 100-08, Medicare Program Integrity Manual sections, including but not limited to, Medicare contractor standard operating procedures for soliciting additional documentation, time limitations for receipt of the solicited documentation, claim adjudication, and recoupment of overpayment. Minimum requirements of a valid SNF PPS claim are: • Revenue Code 0022 must be on the claim. This is the code that designates SNF PPS billing. • A HIPPS code must also be on the claim. This is a five-character code. The first character represents the patient’s physical therapy (PT) component and occupational therapy (OT) component classification. The second character represents the patient’s speech-language pathology (SLP) component classification. The third character represents the patient’s nursing component classification. The fourth character represents the patient’s non-therapy ancillary (NTA) component classification. The fifth character represents the assessment indicator (AI) code. See Pub. 100-04, chapter 6, §30.1 for valid codes and assessment indicators.