Medicare Change Request regarding Billing Instructions Related to Inpatient Expedited Determinations

• By: Maureen Carland
• On: 01/05/2025 09:32:03
• In: Quality/Regulatory

Change Request (CR) 13918, issued December 27, 2024, and effective October 11, 2024, with implementation set for February 15, 2025, provides billing instructions for hospitals and skilled nursing facilities (SNFs) regarding expedited determinations based on Hospital Medicare Change of Status Notifications (MCSNs). These determinations address changes in patient status during an inpatient stay which may impact Medicare coverage or payment in a SNF. 

For SNFs, this CR introduces adjustments to billing workflows, necessitating accurate documentation and adherence to stricter timelines to avoid delays or denials of claims. Staff involved in billing and claims processing may require training to implement these changes effectively. Additionally, SNFs may need to work with their IT teams or software vendors to update systems accordingly and ensure monitoring processes are in place to maintain compliance with the new requirements. These changes aim to streamline status change handling and support accurate Medicare reimbursements.

For more details, see the full transmittal Change Request.
 
Staff contact: mcarland@mehca.org