Providers have begun receiving non-medical additional document requests for claims utilizing the benefit period waiver in response to the COVID-19 public health emergency. These reviewers are being flagged with a “7COVD” code and have primarily been reported under Wisconsin Physician Services (WPS).
These suspended claims may be the result of a billing issue. As such, review the proper guidelines below for how claims involving the waiver for the 60-day wellness period should be billed.
According to this Medicare Learning Network memo, to bill for the benefit period waiver:
- Submit a final discharge claim on day 101 with patient status 01, discharge to home
- Readmit the beneficiary to start the benefit period waiver
For admission under the benefit period waiver:
- Complete a 5-day PPS Assessment. (the interrupted stay policy does not apply.)
- Follow all SNF PDPM assessment rules.
- Include the HIPPS code derived from the new 5-day assessment on the claim.
- The variable per diem schedules begins from day 1.
For SNF benefit period waiver claims, include the following:
- Condition code DR- identifies the claim as related to the PHE
- Condition code 57 (readmission) – this will bypass edits related to the 3-day stay being within 30 days
- COVID100 in the remarks – this identifies the claim as a benefit period waiver request
