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Update on Erroneous Claim Denials for SNF Patients

March 16, 2018 2:05 PM | Amanda Riordan (Administrator)

After the renewal of the ambulance Medicare add-ons, the Centers for Medicare and Medicaid Services (CMS) made a mistake when it uploaded the 2018 SNF Consolidated Billing file. CMS neglected to list the ambulance HCPCS codes (A0425, A0426, etc.) as exempt. As several members have noted, this resulted in many erroneous claims denials for patients in SNFs.

After consultation with experts, FAA believes that this issue has been resolved, and that no action is needed by ambulance providers. FirstCoast is expected to automatically reprocess the erroneous denials fairly quickly.

As a matter of precaution, members are advised to keep a list of impacted claims in case an appeal is needed in the future, within the usual 120 window. (Appeal is not recommended at this juncture as this might limit FirstCoast's ability to automatically reprocess the claim.)

Read the most recent FirstCoast post about this issue.