Wiki SNF Billing & Reimbursement

[daharden]

Our biller has a question. Patient was inpatient beginning 12/2017 under traditional Medicare, and then 1/1/18 switched to Medicare Advantage. The Medicare system will not take our SNF claim, any clue on what codes we need to add to get them to not automatically reject it because patient was under a MA plan on those DOS?

 

[CodingKing]

My understanding prior payer only covers if its inpatient but not SNF. At least thats what this says from UHC.

https://www.uhcprovider.com/content...le-hospitalized-acute-ltc-snf-home-health.pdf

I.2.a

Hospitalization in a Medicare certified skilled nursing facility (SNF)
UnitedHealthcare is responsible for all services beginning on the member’s effective date with the UnitedHealthcare Medicare Advantage plan.

 

[daharden]

My understanding prior payer only covers if its inpatient but not SNF. At least thats what this says from UHC.


Whenever she's called UHC, they’ve quoted me the I. 1. A. section, not the I. 2. A section. UHC is telling her that Med A is supposed to cover it. And that’s what her AAHAM billing book says as well