Z0100: Medicare Part A Billing

Item Rationale

Used to capture the Patient Driven Payment Model (PDPM) case mix version code followed by Health Insurance Prospective Payment System (HIPPS) modifier based on type of assessment.

DEFINITION

MEDICARE-COVERED STAY

Skilled Nursing Facility stays billable to Medicare Part A. Does not include stays billable to other payers (e.g., Medicare Advantage plans).

DEFINITION

HIPPS CODE

Is comprised of the PDPM case mix code, which is calculated from the assessment data. The first four positions of the HIPPS code contain the PDPM classification codes for each PDPM component to be billed for Medicare reimbursement, followed by an indicator of the type of assessment that was completed.

Coding Instructions for Z0100A, Medicare Part A HIPPS Code

Typically, the software data entry product will calculate this value.

The HIPPS code is a Skilled Nursing Facility (SNF) Part A five-position billing code; the first four positions represent the PDPM case mix version code and the fifth is the assessment type indicator. For information on HIPPS, access: https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/ProspMedicareFeeSvcPmtGen/index.html.

If the value for Z0100A is not automatically calculated by the software data entry product, enter the HIPPS code in the spaces provided (see Chapter 6 of this manual, Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS), for a step-by-step worksheet for manually determining the PDPM case mix version code and a table that defines the assessment indicator).

This HIPPS code is usually used for Medicare SNF Part A billing by the provider.

Left-justify the 5-character HIPPS code. The extra two spaces are supplied for future use, if necessary.

Coding Instructions for Z0100B, Version Code

Typically, the software data entry product will calculate this value.

If the value for Z0100B is not automatically calculated by the software data entry product, enter the PDPM version code in the spaces provided.