Claims Part A – Skilled Nursing Facility (SNF) Providers

Claims Part A – Skilled Nursing Facility (SNF) Providers

There has been an increase in overlap claim situations due to Skilled Nursing Facility (SNF) providers not submitting their discharge claims correctly.

There are two situations that force a discharge from a SNF: 1) the beneficiary’s admission as an inpatient to a Medicare participating hospital or Critical Access Hospital (CAH), or 2) the beneficiary’s transfer to another SNF for inpatient services. A beneficiary cannot be an inpatient in more than one facility at a time. Consequently, the SNF must submit a discharge bill if either of these events occur. It is inappropriate to add a 74 span code in lieu of a discharge status. Reference IOM 100-04, Chapter 6, Section 40.3.4

SNF providers shall submit no-payment claims for beneficiaries that previously dropped to non-skilled care and continue to reside in the Medicare-certified area of the facility. The provider must only submit the final discharge bill that may span multiple months but must be as often as necessary to meet timely filing guidelines. Reference IOM 100-04, Chapter 6, Section 40.8

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