Medicare SNF Billing Coverage 2022

Medicare Part A covers skilled nursing and rehabilitation care in a Skilled Nursing Facility (SNF) under certain conditions for a limited time. Coverage for care in SNFs is measured in ‘benefit periods’ or sometimes ‘spell of illness’. In each benefit period, Medicare Part A covers up to 20 days in full. After that, Medicare Part […]

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Determining Drug Coverage for Original Medicare

Determining Medicare Drug Coverage While billing for Skilled Nursing Facility (SNF) or for hospital billing, billers always make the mistake of considering the wrong Medicare drug coverage. For example, Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are covered under Part D. In this article, we shared […]

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Instructions for SNF Advanced Beneficiary Notice of Non-coverage (SNFABN)

SNF Advanced Beneficiary Notice of Non-coverage Medicare requires SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is not medically reasonable and necessary; or considered custodial. The SNFABN provides information to the […]

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Removal of Temporary Emergency Waivers for Nursing Home

During the Public Health Emergency (PHE), The Centers for Medicare & Medicaid Services (CMS) used a combination of emergency waivers, regulations, and sub-regulatory guidance to offer health care providers the flexibility needed to respond to the pandemic. In certain cases, these flexibilities suspended requirements in order to address acute and extraordinary circumstances. Now, CMS is […]

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Proposed Updates for Skilled Nursing Facility Quality Reporting Program (SNF QRP) 

On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities (SNF) for the year 2023. This SNF PPS (Skilled Nursing Facility Prospective Payment System) includes proposals for the SNF Quality Reporting Program (QRP) and the SNF Value-Based […]

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Declaration of Blanket Waivers for SNFs

On 7th April 2022, in response to the COVID-19 PHE and under section 1135 of the Social Security Act, CMS passed several temporary emergency declaration blanket waivers which were intended to provide health care providers with extra flexibilities required to respond to the COVID-19 pandemic. While the waivers of regulatory requirements have provided flexibility in […]

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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs

The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, the authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand […]

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Skilled Nursing Facility 3- Day Rule Waiver

CMS is waiving the requirement at Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF 3- Day Rule Waiver) stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who need to be transferred as a result of […]

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Skilled Nursing Facility (SNF) Consolidated Billing (CB)

Consolidated Billing Background Prior to the Balanced Budget Act of 1997 (BBA), an SNF could elect to furnish services to a resident in a covered Part A stay, either: directly, using its own resources; through the SNF’s transfer agreement hospital; or under arrangements with an independent therapist (for physical, occupational, and speech therapy services). In […]

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How to Fill SNFABN (Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage)?

The SNFABN provides information to the beneficiary so that he can decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. SNFs must use the SNFABN when applicable for SNF Prospective Payment System services (Medicare Part A).  SNFs will continue to use the ABN Form […]

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