Two significant updates to Medicare Part A claims for skilled nursing facilities (SNFs) and hospital swing-bed providers will occur with dates of service beginning August 1, 2011. The Centers for Medicare & Medicaid Services (CMS) is making the following changes through Change Request 7339:
- Any Part A claim reporting an End of Therapy Other Medicare Required Assessment (OMRA) must include Occurrence Code 16 and the date of the last therapy service.
- Therapy units reported with revenue codes 0420, 0430 or 0440 on Part A claims are changed to represent the number of calendar days of therapy provided by discipline, regardless of the number of minutes or types of therapy services provided. According to the CMS Division of Institutional Claims Processing, therapy evaluations will continue to be reported separately under revenue codes 0424, 0434 and 0444.
For example, if a resident was covered by Medicare Part A from August 1 to August 4, 2011, and received physical therapy and occupational therapy services each day during that period, the August claim would include four units of physical therapy and four units of occupational therapy. The number of minutes and types of therapy services for Part A-covered residents is irrelevant for determining the number of units on the claim.
To prepare for these changes, providers should discuss these issues with their software vendor and therapy services provider to determine how information will flow into billing software programs and to Medicare Part A claims.
If you have any questions about this or other SNF Medicare billing issues, contact your BKD advisor.