Adjustments

An adjustment request bill is a correction to a claim previously processed after the provider has gotten notification on a Remittance Advice (RA) as discussed in Lesson 6. If a particular item or service is left off the initial claim, you can submit an adjustment. You must submit adjustment claims before the time limitation expires for filing the initial claim.

Under inpatient PPS, you’re required to submit adjustment bills where errors occur that:

• Result in a change in the Diagnosis Related Group (DRG) for hospitals or Resource Utilization Group (RUG)
• Affect the deductible or use

CMS allows hospitals 60 days and SNFs 120 days from the date of the RA to submit these adjustments. If you find that previous errors have no effect on the DRG or RUG, then you aren’t required to submit adjustment bills.

Review the Medicare Claims Processing Manual, Chapter 1 for details on adjustments for hospitals and SNFs.