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

Proposed Updates for SNF Quality Reporting Program

The SNF QRP creates SNF quality reporting requirements, as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). 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 […]

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 […]

COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs

The Trump Administration is taking aggressive actions and exercising regulatory flexibility to help healthcare providers contain the spread of the 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 […]

Skilled Nursing Facility 3- Day Rule Waiver

CMS is waiving the requirement in 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. This provides temporary emergency coverage of SNF services without a qualifying hospital stay for those who need to be transferred as a result of a disaster […]

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. The consolidated billing requirement confers on the SNF […]

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 […]

Common Denials for SNF and How to Avoid Them?

Denial 1: Certification or Recertification Statement (Missing/ Lacked Information) From 2012-2014 the percentage rate of improper payments to SNF almost doubled all stemming from failure to obtain certification or recertification. General Guidelines: The Certification Statement must include that the individual requires skilled nursing (furnished directly by or requiring supervision of skilled nursing personnel) or skilled […]

Eliminating Skilled Nursing Facilities (SNFs) Medical Billing Complication

Eliminating Skilled Nursing Facilities Medical Billing Complication

Medical billing for Skilled Nursing Facilities has undergone metamorphic changes ever since the Balanced Budget Act of 1997 came into effect in 1998. One of the significant requirements under the new legislation is that Skilled Nursing Facilities are not permitted to unbundle services that are administered by contracted healthcare providers. As a result, most of […]

Reforming Nursing Facilities Medical Billing Amidst Dwindling Eimbursements

Nursing facilities across the U.S. have somehow endured a series of Medicare/Medicaid cuts thus far, but the latest move by CMS to reduce reimbursement for so-called Medicare “bad debt” – Medicare co-payments not made by beneficiaries or state Medicaid programs – may bring them on the threshold of a major operational crisis. The new legislation […]

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Skilled Nursing Facilities Billing Services