Long-Term Care

BALTC Q&A

Billing Alert for Long-Term Care, June 1, 2009

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The Medicare requirements for no-pay claims can be found in Chapter 6, sections 40.8 and 90.2, of the Medicare Claims Processing Manual, which can be accessed from the CMS Web site at . CMS maintains the benefit period and days-paid files in the Common Working File. The only way to maintain this information is for providers to notify CMS through the claims process when these items are affected. The benefits exhaust and no-pay claim billing procedures were developed for this purpose. SNF billers need to submit a benefits exhaust claim when a resident has exhausted his or her 100 days of Medicare Part A coverage but still remains at a skilled level of care based on Medicare guidelines.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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