MLN Publication: SNF Three-Day Qualifying Hospital Stay and Medicare Billing Rules

Skilled Nursing Facility 3-Day Rule Billing Format Fact Sheet ICN: MLN9730256 Publication Description: Learn communication of coverage, claims processing edits, and financial responsibility. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/snf3dayrule-mln9730256.pdf

NHSN Healthcare Personnel (HCP ) Flu Vaccination Module for SNF QRP Reporting

The HCP Flu Vaccination Module, which is part of the HCP component in NHSN, is used to input required NHSN data for the SNF QRP. This site provides access to the HCP Vaccination Module: Influenza Vaccination Summary Protocol, which is the primary manual for the module. In addition, it provides …

COVID-19 PHE End FAQs

The federal PHE for COVID-19, declared under Section 319 of the Public Health Service Act, expired at the end of the day on May 11, 2023. Learn more by reading Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (PDF) (PDF Updated 5/19/2023). From https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

CMS Transmittal: SNF Consolidated Billing HCPCS Code File Update for July 2023

Transmittal # R12052CP Issue Date 2023-05-18 Subject July 2023 Quarterly Update to Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Implementation Date 2023-07-03 CR # 13192 Publication # 100-04 Downloads

Best Practices to Dispute Takebacks for Medicare/Insurance Begin With Prevention

In the 1730s, Benjamin Franklin wrote “An ounce of prevention is worth a pound of cure” to inspire the city of Philadelphia to adopt better fire prevention techniques. What he delivered to history was a maxim (i.e., a core principle) that applies to almost every aspect of life and work—even …

Q&A: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically Complex. Is this a software error?

Question: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically Complex. Is this a software error?   Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, …

TIP: SNFs Still Must Use Condition Code DR After the COVID-19 PHE Ends

The Centers for Medicare & Medicaid Services (CMS) clarified on a recent MLN Connects newsletter that skilled nursing facilities (SNFs) must continue to use the condition code DR (disaster related) on Medicare Part A claims that used the benefit period and/or qualifying stay waivers with admission dates before May 12, …

CMS Transmittal: SNF 5-Claim Probe and Educate Review

Transmittal 12032 issued May 10, 2023, is being rescinded and replaced by Transmittal 12037, dated May 15, 2023, to make a minor clarification (that claims will be adjusted/denied if an improper payment is identified) and remove the confidential designation. All other information remains the same. SUBJECT: Skilled Nursing Facility (SNF) …