Avoiding a Top Denial - Patient in Skilled Nursing Facility

One of the top denial reasons suppliers are receiving is when a patient is in a skilled nursing facility (SNF). To help avoid this denial, suppliers are encouraged to check a beneficiary’s eligibility either through the Noridian Medicare Portal (NMP) or the Interactive Voice Response (IVR) to verify the discharge status code.

On the NMP, under the eligibility tab is Hospital/SNF. The discharge status code will determine if the beneficiary is eligible to receive DMEPOS items as some items may be covered under the Consolidated Billing requirements. Suppliers will need to "click here for discharge status" under the discharge status column for the code to display. It is critical for suppliers to ensure that the discharge status code indicates that the beneficiary has been discharged to home in order to be eligible for coverage.

Suppliers are encouraged to utilize the Consolidated Billing Tool on the Noridian Medicare website to assist them in determining whether a Healthcare Common Procedure Coding System (HCPCS) code is considered under consolidated billing.

Is the beneficiary in a Part A covered stay or in a SNF after the Part A stay has ended, or have they been discharged to home?

Inpatient SNF Hospital Summary

Each table will display a summary of the "Earliest and Latest Billing Dates" with the following information:

Note: If the patient discharge status code does not reference that the beneficiary has been discharged to home, suppliers may need to work directly with the facility to ensure the discharge did occur and that the medical record is updated accordingly.

Last Updated Aug 20 , 2024