CMS Pub. 100-04, ch. 1, § 130.3.1

Requests

(Rev. 4201, Issued: 01-18-19, Effective: 02-19-19, Implementation: 02-19-19)

The term Medicare beneficiary identifier (Mbi) is a general term describing a

beneficiary’s Medicare identification number. For purposes of this manual, Medicare

beneficiary identifier references both the Health Insurance Claim Number (HICN) and

the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition

period and after for certain business areas that will continue to use the HICN as part of

their processes.

SNF inpatient adjustment requests adhere to the same billing instructions as non-inpatient

adjustment requests with the following changes. When an initial bill has been submitted

and the provider or FI discovers an error on the bill, an adjustment request is submitted if

the change involves one of the following:

• A change in the Part B cash deductible of more than $1.00

• A change in the number of inpatient days;

• A change in the blood deductible;

• A change in provider number;

• A change in coinsurance which involves an amount greater than $1.99;

• A change in the HIPPS code to correct a data input error or,

• Effective for changes for services June 1, 2000, change in HIPPS code due to an

MDS correction. (Such adjustments are required within 120 days of the through

date on the initial bill.) NOTE: See Chapter 6, Section 35 for information on

submitting adjustments to HIPPS codes resulting from MDS corrections.

Late charge billings (type of bill xx5) are not acceptable for SNF PPS Part A services.

The reason for an adjustment (Claim Change Reasons) is reported in one of the condition

code fields. Claim Change Reason Codes applicable to SNFs are:

D0 Changes to Service Dates D6 Cancel only to repay a duplicate OIG

payment

D1 Changes to Charges D7 Change to Make Medicare Secondary

Payer

D2 Changes in Revenue codes/ HCPCS -

HIPPS

D8 Change to Make Medicare Primary

Payer

D4 Changes in Grouper code D9 Any Other Change

D5 Cancel to correct Medicare

beneficiary identifier or Provider ID

E0 Change in Patient Status

The SNF selects the one code that best describes the change reason. An adjustment may

contain multiple changes even though only one reason code is reported.