Medical Billing Q&A: Demand Billing
Q: What is demand billing and how a claim is submitted?
A: Demand bills are only required to be billed when a beneficiary or their representative chooses the option 1 for a demand bill on the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN). This option may be chosen because the beneficiary or their representative wants to challenge the facility’s decision on the beneficiary’s level of care. Demand bills are not required unless this option is chosen and should not be submitted for every beneficiary who drops below a skilled level of care for Medicare coverage.
A demand bill should be submitted as a non-covered claim, similar to a 210 no-pay claim. The non-covered claim should contain a condition code 20 and should begin the day after a beneficiaries last covered day and end on the last day of the month. Once received by Medicare, the claim will suspend for medical review and an Additional Document Request (ADR) letter will be mailed to the provider with a list of the requested medical documentation and where to send it. Once the ADR documentation is received by Medicare, it will be reviewed to determine if Medicare agrees or disagrees with the providers level of care decision of the beneficiary.
A provider may not bill the beneficiary (except for non-covered items such as hair care, television, or telephone) until the MAC has made their decision of the demand bill. Find more information in the Novitas Solutions Demand Bill Guide.
If you have a medical billing question, please email it to Angela Briggs and we will gladly feature it in a future newsletter.
