CMS Confirms Some PDPM Claim-Processing Errors, Promises Fix by October

The federal government on Thursday acknowledged some errors in processing Medicare claims under the new payment system for nursing homes, promising to make a full correction by the start of its next fiscal year.

The main issue has to do with the sequence of initial claim filings for Patient-Driven Payment Model (PDPM) reimbursements, the Centers for Medicare & Medicaid Services (CMS) announced in a release from the Medicare Learning Network. 

“Initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate,” the agency noted. “Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October.”


The federal government’s fiscal 2021 begins this coming October 1.

Until then, CMS advised nursing homes to submit claims in the proper sequence, waiting two weeks before billing for additional claims.

“To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then re-bill in sequential order; or, hold adjustments (when allowable) until October, when they will process correctly,” CMS advised, adding that operators should submit a complete bill at the time of entry.


The shift to PDPM, which officially took effect this past October 1, has largely gone smoothly, with only a few technical updates from CMS required to ensure uninterrupted billing — and multiple analyses showing generally increased reimbursements for operators across the country.

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