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Skilled Nursing Facilities - Revenue code 0551, 0552
• Skilled Nursing
o 0551 – visit charge
o 0552 - hourly
• Indicate “21X”, “22X” or “23X” in type of bill field, which is field 4 for paper claims.
o First digit – Type of facility (2)
o Second digit – Bill classification (inpatient - 1, inpatient Medicare B only - 2 or outpatient - 3)
o Third digit – Frequency (e.g., admit thru discharge claim, etc.)
• Hospital Swing Bed claims should be billed with the “18X” type of bill and the taxonomy code for the hospital’s swing bed unit.
• For Florida Blue and BlueOptions members, provide the authorization/certification number on the claim. Plan of treatment should not be submitted with claim, unless requested.
• Submit room and board units to reflect the length of stay minus one unit for the discharge day. Day of discharge or death is not considered a covered day, unless admitted and discharged/deceased on the same day. For example, if a claim is submitted for dates of service 8/1/2014 to 8/7/2014, then the room and board units should be 6 to exclude the day of discharge or death.
• Refer to contractual reimbursement terms to determine if billing is based on Skilled Nursing Facility (SNF) revenue codes or HIPPS RUG codes. Typically only Medicare Advantage provider contracts are negotiated based on the inpatient prospective payment system for SNFs.
• Florida Blue requires SNF claims are submitted with the 191-194 or 199 revenue codes that represent sub-acute care. Any inpatient SNF claims for Non-BlueMedicare members that do not contain these specific room and board codes will be returned to the provider for appropriate billing.
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