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June 26, 2020

CMS provides detailed billing guidance for claims with extended spell of illness. Today, the Centers for Medicare and Medicaid Services (CMS) released an update to the MLN Matters article SE20011. The update provides detailed billing instructions for claims and claims corrections related to the SNF beneficiaries who, under the CMS COVID-19 emergency waivers, had their benefit period extended beyond the normal 100-day period. CGS provided some general guidance on a webinar on May 28, but providers continued to struggle with claim processing and correction in various situations. The updated article provides detailed billing information (starting on page 11) on condition codes, guidance on remark and condition codes, discharge and readmission claims, and correction of claims previously rejected. CMS also provides more detailed explanations on when the waiver is appropriate to use as well as documentation requirements. A summary of key points is provided below:

  1. Submit a final discharge claim with patient status 01 on the last covered day.
  2. Admit the beneficiary the following day (Day 101) to start the benefit waiver period.
  3. Use condition code DR - identifies the claims as related to the Public Health Emergency.
  4. Use condition code 57 (readmission) - this will bypass edits related to the 3-day stay being within 30 days.
  5. Enter “COVID100” in the remarks - this identifies the claim as a benefit period waiver request.

For questions or clarifications regarding these instructions, please contact Erin Begin

COVID-19 cases spiking? We don't normally report on general COVID-19 statistics, but the news is starting to become alarming. Today the state reported 987 new cases, on the heels of 892 yesterday. These numbers are the highest daily case totals since the pandemic began, save for a few days in April when the figures were distorted because of prison testing results. While it is too early to tell if it is a true spike following re-opening of many businesses and activities, the new cases are disproportionately among younger people. By contrast, the number of cases in SNFs, assisted living communities, and ICFs/IID fell precipitously from 2,061 on May 28 to 913 on June 24. The numbers don't line up temporally with the last two days' reports, so it remains to be seen if there will be any impact.

Pop-up testing sites next week. Please see this list for the pop-up COVID-19 testing sites for next week. At these sites, anyone, including SNF staff, can be tested for free.

MCO Collaborative AL resident and discharge planning update. Medicaid managed care organization (MCO) representatives informed OHCA that the MCO Collaborative is able to participate actively in relocating COVID-19-positive assisted living residents to appropriate levels of care, including SNF or hospital, and to the community where applicable. Unfortunately, the plans have no way of coordinating admission to Health Care Isolation Centers at this time. The MCO Collaborative Congregate Team is developing a new discharge planning tool for inter-level transfers. Beneficiaries will be evaluated on a case-by-case basis for relocation, and level of care (LOC) will apply. Factors such as physical plant and resident needs will determine which destination the discharge planning team may suggest for a possible resident relocation.   

The MCOs remind providers that they can request assistance with discharge planning for members by contacting the dedicated case manager for the member and if unknown, by utilizing the apprpropriate contacts below:

Aetna: Andrea Price, LTSS Director,; Kendra Marks, UM Director,

Buckeye: Christina Brim, Manager UM/PAL-CBRIM@CENTENE.COM; Chris Skock, Sr. Manager UM, CSKOCK@CENTENE.COM

CareSource:; Jennifer Anadiotis, Director Post-Acute,

Molina: Medicaid at MolinaMedicaidLTC@MolinaHealthCare.Com; MyCare at


United Healthcare: Matt Shula, Director NF Services, MATTHEW.SHULA@UHC.COM

CMS Webinar: "State Partnerships to Support COVID-19 Prevention and Response in Nursing Homes." CMS circulated the following announcement about a webinar on Tuesday.

Please join us for a National Learning and Action Network (LAN) event on Tuesday, June 30, 2020 from 2:00-3:00 PM ET. This presentation will provide an overview of the different activities and resources that State Healthcare-associated Infections and Antibiotic Resistance (HAI/AR) prevention programs and Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) are offering to assist nursing homes during the COVID-19 pandemic.


  1. HAI/AR prevention program COVID-19 response activities and resources for nursing homes
  2. QIO Program COVID-19 prevention activities and resources for nursing homes
  3. Opportunities for coordination and partnership (examples could include provider outreach, Tele-ICAR activities and NHSN support)
  4. Please join us and be prepared to share your experiences!

Registration Instructions:

  1. Register at
  2. Once you register, you will receive an email with your individual web link to join the webinar.
  3. The web link you receive will work for only one user, so if you would like to forward this event to additional team members, please send them the registration link.
  4. Please note that registration for this event is limited. It is recommended that you sign into the webinar in advance of the start of the event to ensure participation.


Please direct any questions to The Bizzell Group at