Skilled Nursing Facility (SNF) - JE Part A

• Billing
• Application Requirements
• Application Time Frame

Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10 Section 10.2.1.14 and CMS Internet Only Manual (IOM), Publication 100-07, Medicare Program Integrity Manual, Chapter 7 Section 7004

• A Skilled Nursing Facility (SNF) is a facility that:
  • Is primarily engaged in providing to residents skilled nursing care and related services for residents who require medical or nursing care; or
  • Is primarily engaged in providing to residents skilled rehabilitation services for the injured, disabled, or sick persons and is not primarily for the care and treatment of mental diseases
  • Has in effect a transfer agreement (meeting the requirements of §1861(1) of the Social Security Act with one or more hospitals having agreements in effect under §1866 of the Social Security Act); and
  • Meets the requirements for a skilled nursing facility described in subsections (b), (c), and (d) of §1819 of the Social Security Act
• There is only 1 PTAN and one practice location per SNF
• SNFs are normally attached to hospital

Billing for SNF

• For more information regarding billing, go to the billing portion of the website.

Application Requirements

• Must have the following attachments
  • Submit 3 organizational structure diagrams or flowcharts:
    • A chart identifying all the entities listed in Section A of the Organizations section of the Attachment that shows their relationships with the SNF and each other. (This chart will thus include the SNF’s organizational ADPs.)
    • A chart identifying the organizational structures of all its owners, including owners not listed in the SNF Attachment (e.g., less than 5% direct or indirect owners of corporations).
    • A chart outlining the organizational structures of each ADP of the facility. This must include a written description of the relationship of each ADP to the facility and to all the SNF’s other ADPs.
    At least one of these three charts must also identify the SNF’s ultimate parent company and the entities situated between the SNF and the parent in the organizational arrangement. Also, the charts must be three separate ones and should not be combined into one or two.
  • Include a transfer agreement
• SNF can be a separate institution or a "distinct part" – meaning an area or portion of an institution that is certified to furnish SNF services
  • Each will receive their own PTAN
  • A hospital may have only 1 SNF "distinct part"
  • "Distinct part" designation is not equivalent to being "provider-based"

Swing-Bed Approved

• Approved by CMS to furnish post-hospital skilled nursing facility (SNF) services
• Hospital or CAH patients' beds can "swing" from furnishing hospital services to providing SNF care without the patient necessarily being moved to another part of the building
• As stated in 42 CFR §482.66, to obtain swing-bed status the hospital must
  • Have a Medicare provider agreement
  • Be in a rural area
  • Have fewer than 100 non-newborn or intensive care beds
• Submit 855A change application to add the swing bed unit as a practice location via paper
• Submit 855A initial application to add the swing bed unit as a practice location via PECOS
• Will be given an additional PTAN to bill for swing-bed services (the third digit of the PTAN will be the letter U, W, Y, or Z)

Note: Swing Bed Providers do not need to submit any documentation to Medicare if they want to add beds to their unit.

Application Time Frame

Note:

1. Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the State Agency and CMS. There is no set timeframe for their review.
2. Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.