SNF Billing: Patients who had a procedure by a physician practice participating in BPCI. 10.27.14

Q: As a SNF biller, is there anything different that needs to be added to the claim when billing for a Medicare Part A covered patient who had a procedure by a physician practice (awardee) participating in the Bundled Payments for Care Improvement Initiative (BPCI)  where the 3-day hospital stay could be waived (Awardee dependent)?

A: When submitting claims to Medicare that require a waiver of the 3-day hospital stay requirement for Part A SNF coverage, SNF billing staff must enter a "62"in the Treatment Authorization Code Field. This allows MACs to appropriately pay SNFs treating beneficiaries for services initiated in the hospital setting by Awardees who have applied for and have qualified for a waiver of the Medicare payment policy requiring a 3-day hospital stay prior to coverage of SNF services for a given beneficiary.

For more information, please refer to  MedLearn Matters Number: MM8792 with Effective Date of 10/27/14.