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When releasing these claims, enter condition code 15 to indicate they are clean claims in which payment was delayed due to a CMS processing delay and are therefore, not subject to contractor performance evaluation for claims processing timeliness standards.
What is a pep adjustment for Medicare?
In both the transfer and discharge with readmission cases, the proration takes the form of a partial episode payment (PEP) adjustment, in which the claim payment for the services prior to the transfer or discharge is multiplied by the number of days between the first and last billable visits divided by 60.
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