Long-Term Care

Clearing up MA HIPPS codes on claims

Billing Alert for Long-Term Care, October 1, 2014

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An explanation is in order. Originally, when billing for all Medicare Advantage organizations (MAO), PACE organizations, cost plans, and certain demonstration projects, providers were told by CMS that they must provide health insurance prospective payment system (HIPPS) codes for skilled nursing facility (SNF) claims submitted effective July 1, 2014. This left SNF providers concerned that they would then be required to follow the traditional Medicare PPS schedule in order to accurately provide HIPPS codes for billing. On May 23, 2014, CMS released a memo regarding submission of HIPPS codes to the encounter data system to all MAO providers clarifying the requirements.

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