Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013. Medicare systems were not updated in…

This is an update to the issue identified where some SNF claims (type of bill 21x) were being cancelled erroneously for not meeting the three day qualifying hospital stay requirement when in fact the requirement was met. After further analysis by the Common Working File (CWF), it was determined that this only impacted SNF claims where the…