• Preventing Part A SNF PPS Denials

    September 22, 2017

    Preventing Part A SNF PPS denials (SNF): The CMS Medicare Learning Network (MLN) Connects newsletter has provided the following information and resource links for SNFs to help prevent errors that commonly result in SNF Part A Prospective Payment System (PPS) payment denials. Click here to view the article. 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