Monday, August 21, 2017

CMS Provider Compliance Resources to Prevent Part A SNF PPS Denials

This week, the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN) Connects newsletter provided the following information and resource links for skilled nursing facilities (SNFs) to help prevent errors that commonly result in SNF Part A Prospective Payment System (PPS) payment denials:

According to the 2015 Comprehensive Error Rate Testing (CERT) Report, the denial rate for SNFs increased from 6.9 percent in 2014 to 11 percent 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


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