Skilled nursing facility sequential billing

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Home ► Skilled nursing facility ► Skilled nursing facility sequential billing

Last Modified: 4/1/2024 Location: FL, USVI, PR Business: Part A

Skilled nursing facility sequential billing

A skilled nursing facility (SNF) must submit a patient's claims monthly in the order in which the services were received. All claims must be in sequential order and the current claim submission must be finalized before the next claim is submitted.

Claims are processed in the order in which they were received (first-in/first out). The claims processing system will search the patient's claim history for the prior month's claim before processing.

Claims submitted out of sequential order will return to provider (RTP).

Example

Patient admitted to SNF in October and remains in the SNF until the end of January:

• Submit October claim first.

• After the October claim finalizes, submit the November claim.

• After the November claim finalizes, submit the December claim.

• After the December claim finalizes, submit the January claim.

If a SNF submits the October claim followed by the December claim, the December claim will RTP because the November claim was not submitted. The November claim must be submitted and once finalized, the December claim can be submitted.

If the SNF submits the November claim before the October claim finalizes, the November claim will RTP. The SNF must wait until the October claim finalizes before submitting the November claim.

If the SNF submits the November claim followed by the October claim, the October claim will reject as an overlap billed out of sequence. To get the October claim processed, the November claim must be cancelled and then submit the October claim. Once the October claim finalizes, resubmit the November claim.

Reference

• CMS IOM Pub.100-04, Medicare Claims Processing Manual, Chapter 6, sections 40.1 and 40.2 external pdf file

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