Skilled Nursing Facility (SNF) - JE Part A
Skilled Nursing Facility (SNF)
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
PECOS application
- "Institutional Provider" (e.g., Hospital, Skilled Nursing Facility, Hospice, Home Health Agency)
- Complete questionnaire to ensure correct applications (CMS-855A, CMS 588-EFT, and ATTACHMENT 1: SKILLED NURSING FACILITY DISCLOSURES.) populate.
CMS-855A
- Complete all form sections and ATTACHMENT 1: SKILLED NURSING FACILITY DISCLOSURES
- Include all supporting documentation such as the IRS documents and transfer agreement
- List all directors, board members, and contracted or W-2 managing employee
- Visit the Application Fee webpage to access CMS link to pay application fee
CMS-588 EFT
- Submit completed CMS-588 EFT and voided check/bank letter. EIN required to be on application in Tax Identification Number (TIN) field
- Must have the following attachments
- Submit 2 organizational structure diagrams or flowcharts:
- One chart must identify all the entities listed in Section A and show their relationships with the provider and each other.
- One chart must identify the organizational structures of all its owners, including owners not listed in this attachment (e.g., less than 5% direct or indirect owners).
- Include a transfer agreement
- Submit 2 organizational structure diagrams or flowcharts:
- 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
Application Type | Processing Time |
---|---|
PECOS | On average, it can take 15 to 50 calendar days before application is sent to state and CMS for approval |
Paper | On average, it can take 30 to 65 calendar days before application is sent to state and CMS for approval |
Note:
- 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.
- Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.