Decoding SNF Billing: Essential Occurrence Codes and Their Impact on Claims

Decoding SNF Billing: Essential Occurrence Codes and Their Impact on Claims

Navigating the world of Skilled Nursing Facility (SNF) billing can be complex, especially when it comes to understanding and using occurrence codes correctly. These alphanumeric indicators provide critical information that affects how claims are processed, reimbursed, or denied. Inaccurate usage can lead to delayed payments, compliance issues, or rejections—making it vital for medical billers and SNF staff to be well-versed in them.

In this blog, we’ll dive into the most frequently used SNF occurrence codes, explain what they signify, and highlight why they’re so important for ensuring clean claim submissions and steady cash flow.

What Are Occurrence Codes in SNF Billing?

Occurrence codes are two-digit codes used on UB-04 claim forms to convey important events related to the patient’s care, eligibility, or insurance. These codes are paired with dates and help clarify the timing or reason behind a specific healthcare event. In SNF billing, they play a crucial role in determining whether the claim aligns with Medicare or other payer requirements.

Top Occurrence Codes in SNF Billing — and What They Mean

• Occurrence Code 01 – Auto Accident Date: Indicates the date of an auto accident, if the services are related to injuries sustained in one. Essential when dealing with liability claims or coordination with auto insurers.
• Occurrence Code 06 – Crime-Related Injury: Used when treatment is linked to injuries from a crime. Helps establish the context of care, especially when law enforcement or other insurance policies are involved.
• Occurrence Code 11 – Onset of Symptoms/Illness: This date signifies when the patient’s symptoms or illness first appeared. It is particularly important when justifying medical necessity for long-term care admissions.
• Occurrence Code 18 – Date of Retirement: Used when a patient has retired, which can affect their Medicare eligibility or primary insurance status. Correct usage avoids coordination of benefit issues.
• Occurrence Code 27 – Date of Hospice Certification: Relevant when a patient switches to or from hospice care while in an SNF. It ensures accurate billing when services overlap or transition.
• Occurrence Code 32 – Date Beneficiary Notified of Liability: Important in cases where an Advance Beneficiary Notice (ABN) is issued. This date clarifies when the patient was informed that Medicare may not cover certain services.
• Occurrence Code 50 – Medicare Pay Date: Reflects when the patient’s Medicare coverage became active. Ensures correct payer is billed and helps avoid claim denials due to coverage lapses.
• Occurrence Code 55 – SNF Bed Hold: Used when a patient is temporarily absent from the SNF (e.g., hospitalized), but the bed is being held for their return. Crucial for billing per diem rates during these transitions.
• Occurrence Code 60 – Assessment Reference Date (ARD): Marks the reference date for MDS (Minimum Data Set) assessments, which determine case-mix and payment under PDPM (Patient Driven Payment Model).

Why Accurate Occurrence Code Reporting Matters

Using the correct occurrence codes isn’t just a box-ticking exercise. Here’s why they’re crucial:

• Reduces claim denials by ensuring proper documentation and payer understanding.
• Supports compliance with Medicare and Medicaid rules.
• Improves reimbursement timelines through cleaner claims.
• Enables better audit readiness in the event of a payer review.

Incorrect or missing occurrence codes can trigger audits, overpayment recoveries, or non-payment. That’s why it’s essential for SNF billing staff to stay trained and updated.

Best Practices for Managing Occurrence Codes

• Cross-check codes with patient documentation regularly.
• Train billing and admissions staff on current coding guidelines.
• Use billing software that prompts for necessary codes during claim generation.
• Stay updated on payer-specific requirements and CMS updates.

Partnering with Experts for SNF Billing Success

At [Your Company Name], we specialize in Skilled Nursing Facility billing, including accurate occurrence code reporting. Our team ensures compliance, maximizes reimbursements, and reduces claim errors—helping your facility focus more on patient care and less on paperwork.

Final Thoughts

Occurrence codes might seem minor, but their impact on SNF billing is major. Knowing what each code represents—and using it correctly—can prevent payment disruptions and streamline your revenue cycle.

If your facility is struggling with denied claims or code confusion, now’s the time to reach out for expert support. Let’s simplify your billing, one code at a time.