CMS Corrects Guidance on Billing for 3-Day Waiver Admissions (SNF)

The Centers for Medicare and Medicaid Services (CMS) published updated claim coding guidance about the use of the DR condition code on claims after the end of the PHE. This guidance, “COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency,” corrects guidance previously posted on March 16.

Important: 

• The updated guidance explicitly states that, for 3-day qualifying hospital stay waivers, skilled nursing facility and swing bed providers should continue to submit condition code DR for Medicare Part A claims for residents with admission dates before May 12, 2023.
• This means that the DR condition code would be on claims for those residents until they are discharged from Medicare Part A coverage or until their 100-day benefit period is exhausted.
• The DR condition code should not be used on SNF Part A claims for residents with dates of admission on or after May 12, 2023.
• For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38​.