CMS Pub. 100-04, ch. 6, § 40.9

A. Demand Bills

Where the SNF believes that a covered level of care has ended but the beneficiary

disagrees, they report occurrence code 21 (UR notice received) or 22 (date active care

ended) as applicable and condition code 20 indicating the beneficiary believes the

services are covered beyond the occurrence date.

See the Medicare Claims Processing Manual, Chapter 1, “General Billing Requirements,”

§60.3, for instructions on advance beneficiary notices and demand bills.

Refer to the Medicare Claims Processing Manual, Chapter 25 for further information

about billing.

B. Request for Denial Notice for Other Insurer

The SNFs complete a noncovered bill and enter condition code 21 to indicate a request

for a Medicare denial notice. Refer to Chapter 25 further information about billing.

C. Another Insurer is Primary to Medicare

See the Medicare Secondary Payer (MSP) Manual, Chapter 3, “MSP Provider Billing

Requirements” and Chapter 5, “Contractor Prepayment Processing Requirements,” for

submitting claims for secondary benefits to Medicare. Refer to the Medicare Claims

Processing Manual, Chapter 25 for further information about billing.

D. Special MSN Messages

The Medicare Prescription Drug Improvement and Modernization Act of 2003 requires

that Medicare Summary Notices (including SNF claims for post-hospital extended care

services provided under Part A) report the number of covered days remaining in the given

spell of illness. This requirement became effective July 6, 2004.

E. Interrupted Stay

Refer to the Medicare Claims Processing Manual, Chapter 6, “Interrupted Stay Policy,”

§120.2, for information about billing when a patient returns to a covered level of care

after an interrupted stay.