Occurrence Code 22 indicates the date active care ended, specifically marking when covered Skilled Nursing Facility (SNF) level of care concluded. This critical code is essential in healthcare billing to accurately report the termination of a specific type of patient care.
Understanding Occurrence Code 22
In healthcare claims processing, particularly for institutional claims like those submitted on a UB-04 form, various "occurrence codes" are used to report significant events and dates related to a patient's stay or services. Occurrence Code 22 serves a very specific purpose: to pinpoint the date active care ended.
This code specifically refers to the end date of covered services at a Skilled Nursing Facility (SNF) level of care. It is a crucial detail for payers, as it defines the precise period for which SNF services are being claimed.
Key Aspects and Requirements
- Date Active Care Ended: The primary function of Code 22 is to capture the exact day when a patient's active, covered SNF level of care ceased. This could be due to discharge, a change in the required level of care, or the patient no longer meeting SNF criteria.
- Matching Claim Dates: A fundamental requirement for using Occurrence Code 22 is that the date reported with it must match the "statement covers through date" on the claim. This ensures consistency and accuracy in the billing period presented to the payer. For example, if a claim states it covers services up to January 15, 2023, then Occurrence Code 22 should also reflect January 15, 2023, as the date active care ended.
- Billing and Reimbursement: Accurate reporting of this code is vital for proper reimbursement and compliance. Discrepancies between the date active care ended and the statement covers through date can lead to claim denials or delays in processing.
Practical Application
Consider a patient who was receiving skilled nursing care and was discharged from a facility.
- Scenario: A patient was admitted to an SNF on December 1, 2022, and discharged on January 10, 2023, as their need for a covered SNF level of care ended.
- Claim Entry: On the UB-04 claim form, the facility would list:
- Occurrence Code 22: 01-10-2023 (January 10, 2023)
- Statement Covers Through Date: 01-10-2023 (January 10, 2023)
This matching ensures the payer understands that covered SNF care concluded on January 10th and the claim period reflects that.
Importance in Healthcare Billing
| Aspect | Description |
|---|---|
| Accuracy | Ensures that claims accurately reflect the duration of covered SNF services, preventing over-billing or under-billing. |
| Compliance | Adherence to billing guidelines set by payers, such as Medicare, Medicaid, and private insurance companies, is crucial. This code helps facilities remain compliant. For more details on billing guidelines, refer to CMS Manuals (Note: External link to CMS). |
| Auditing | Facilitates easier auditing processes by providing a clear and consistent date for the end of active care, which can be cross-referenced with patient medical records. |
| Reimbursement | Correctly reported dates lead to smoother claim processing and timely reimbursement for services rendered. |
By precisely indicating the end of active SNF-level care, Occurrence Code 22 plays a significant role in maintaining the integrity and efficiency of the healthcare billing system.
