Reminder: Payment methodology updated for MA admissions to skilled nursing facilities

As we previously announced, Medicare Plus Blue^SM PPO and BCN Advantage^SM have changed their payment methodology for skilled nursing facilities. As of Oct. 1, 2019, the payment methodology changed from resource utilization group levels to patient-driven payment model levels during the patient’s stay (from preservice through discharge).

This update to the payment methodology:

• Applies to skilled nursing facility admissions with dates of service on or after Oct. 1, 2019
• Aligns with the Centers for Medicare & Medicaid Services’ payment methodology for skilled nursing facilities

As a reminder, naviHealth manages authorization requests for Medicare Plus Blue PPO and BCN Advantage members admitted to post-acute care on or after June 1.

When submitting claims for stays with dates of service starting on or before Sept. 30, 2019, and extending through or beyond Oct. 1, 2019, you need to include both the RUG levels and the PDPM levels that naviHealth authorized.

For more information, review:

• The Patient Driven Payment Model (PDPM) — Information and Resources for Provider Partners**
• Post-acute care services: Frequently asked questions for providers

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.