Medicare SNF Billing Coverage 2022

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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 A covers an additional 80 days with
the beneficiary paying coinsurance for each day.
After 100 days, the SNF coverage available during
that benefit period is exhausted, and the
beneficiary pays for all care, except for certain
Medicare Part B services. In this article, we
shared Medicare SNF billing coverage for the year
2022, and also we bifurcated Medicare SNF billing
coverage for Medicare part A, Medicare part B,
Original Medicare, and Medicare Advantage
(MA). Medicare Part A Coverage The SNF
Prospective Payment System (PPS) pays for all SNF
Part A inpatient services. Medicare Part A
covers Medicare-certified SNF skilled care.
Skilled care is nursing or other rehabilitative
services, provided according to physician orders,
that
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Medicare SNF Billing Coverage 2022

• Require skills of qualified technical or
  professional health personnel, like registered
  nurses, licensed practical (vocational) nurses,
  physical therapists, occupational therapists, and
  speech-language pathologists or audiologists
• Are provided directly by, or under general
  skilled nursing or skilled rehabilitation
  personnel supervision, to assure patient safety
  and medically desired results
• General supervision requires initial direction
  and periodic inspection of the actual activity
  the supervisor isnt always physically present or
  at the location when the assistant performs
  services
• Medicare considers a service skilled if its
  inherent complexity can only be performed safely
  and or effectively by, or under the general
  supervision of, skilled nursing or skilled
  rehabilitation personnel. Under the consolidated
  billing provision, SNF Part A inpatient services
  include all Medicare Part A services considered
  within the scope or capability of SNFs. In some
  cases, the SNF must obtain some services it does
  not provide directly. For these services, the SNF
  must make arrangements to pay for the services
  and must not bill Medicare separately for those
  services.
• Medicare Part B Coverage

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Medicare SNF Billing Coverage 2022

• Medicare Part B may pay for some services
  provided to beneficiaries residing in an SNF
  whose benefit period exhausted or who are not
  otherwise entitled to payment under Part A
  outpatient services rendered to beneficiaries who
  are not inpatients of an SNF, and services
  excluded from SNF PPS and SNF consolidated
  billing. Bill repetitive services monthly or when
  treatment stops. Bill one-time services when you
  complete the service. You can refer Medicare
  Claims Processing Manual, Chapter 7 for detailed
  information.
• Original Medicare Coverage
• Original Medicare enrollees must meet these
  conditions to qualify for Part A-covered SNF
  services
• The patient was a hospital inpatient for a
  medically necessary stay of at least 3
  consecutive calendar days
• Time spent in observation or in an emergency room
  doesnt count toward a medically necessary 3-day
  qualifying inpatient hospital stay
• A Medicare Advantage (MA) plan, 1876 Cost plan,
  or Program of All-inclusive Care for the Elderly
  (PACE) plan may waive the 3-day stay for
  enrollees
• Patient transferred to Medicare-certified SNF
  within 30 days after hospital discharge, unless
  both are true

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Medicare SNF Billing Coverage 2022

• The patients condition makes it medically
  inappropriate to begin active treatment in an SNF
  immediately after discharge
• Its medically predictable at patients hospital
  discharge that theyll need covered SNF care
  within a predetermined time period (generally no
  more than 30 days), and they meet that prediction
• The patient needs daily skilled nursing or
  rehabilitation services
• Daily skilled services can happen only in an SNF
  on an inpatient basis if
• They arent available on an outpatient basis in
  the patients location
• When compared to an inpatient setting,
  transportation to a facility is
• Excessive physical hardship
• Less economical
• Less efficient or effective
• Services are reasonable and necessary for
  diagnosing or treating a patients qualifying
  condition and of reasonable duration and quantity
• Medicare Advantage Coverage

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Medicare SNF Billing Coverage 2022

• Medicare Advantage (MA) plans, 1876 Cost plans,
  or PACE plans typically waive the 3-day
  hospitalization requirement. MA plans must cover
  the same number of SNF days Original Medicare
  covers, but they may cover more. Note that For MA
  plan patients, check with the MA plan for
  information on eligibility, coverage, and
  payment. Each plan can have different patient
  out-of-pocket costs and specific rules for
  getting and billing for services. You must follow
  the plans terms and conditions for payment.
• MA plans may offer different benefit periods
• Each MA plans Evidence of Coverage (EOC)
  describes all its benefits, including SNF
  coverage
• Most MA plans offer SNF coverage through network
  providers paid according to their contracts
• Non-network SNFs should confirm MA coverage with
  the enrollees MA plan
• MA plans that cover SNF services provided by
  non-network SNFs pay the Original Medicare
  payment rate
• 3-Day Prior Hospitalization
• A patient meets the 3-consecutive-day stay
  requirement by staying 3 consecutive days in 1 or
  more hospital(s). Only the admission day, not the
  discharge day, counts as a hospital inpatient
  day. Time spent in observation or in the
  emergency room before admission doesnt count
  toward the 3-day qualifying inpatient hospital
  stay.

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Medicare SNF Billing Coverage 2022
3-Day Stay Waiver Certain SNFs that have a
relationship with Shared Savings Program (SSP)
Accountable Care Organizations (ACOs) may waive
the SNF 3-day rule. Occasionally, during a Public
Health Emergency, we may issue a temporary
waiver. Most MA plans waive the 3-day
hospitalization requirement. We hope that this
Medicare SNF billing coverage for the year 2022
would be helpful in accurately billing Medicare
for SNF services. In case of any assistance
needed in Skilled Nursing Facility (SNF) billing,
contact Medical Billers and Coders
(MBC) at info_at_medicalbillersandcoders.com or call
us 888-357-3226.