Wednesday, March 22, 2017

CMS Reminds SNFs How to Prevent Physician Certification Denials

Dan Ciolek


A Centers for Medicare and Medicaid Services (CMS) MLN Connects March 16, 2017 e-newsletter provided the following reminders and educational resources to help SNF providers avoid SNF PPS denials due insufficient physician certification documentation. SNF billing and compliance personnel are encouraged to review the following information.  


“According to the 2015 Comprehensive Error Rate Testing (CERT) Report, the denial rate for Skilled Nursing Facilities (SNFs) increased from 6.9% in 2014 to 11% in 2015 due to missing or incomplete certification/recertification:


· Statement must contain need for skilled services that can only be provided in SNF/swing-bed on a daily basis for a condition patient was treated for in prior hospital stay

· Must include physician’s dated signature (printed name if signature is illegible)

In addition, recertifications should include:

· Expected length of stay

· Explanation if continued need for services is for a condition that arose after SNF admission

· Any plans for home care

Resources:

· CERT: SNF Certifications and Recertifications MLN Matters® Special Edition Article

· SNF Billing Reference Fact Sheet

· Medicare Fee-For-Service 2014 Improper Payments Report, page 19

· Medicare Fee-For-Service 2015 Improper Payments Report, page 18”

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