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
Application | Tips |
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PECOS application |
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CMS-855A |
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CMS-588 EFT |
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- Must have the following attachments on Initials, Reactivations or Revalidations, and changes in section 5 and/or 6
- Diagram/flowchart identifying the organizational structures of all its owners, including those that were not required to be listed in section 5 or 6
- Must be submitted in addition to the diagram/flowchart for Section 5 Entities
- Include a transfer agreement
- Diagram/flowchart identifying the organizational structures of all its owners, including those that were not required to be listed in section 5 or 6
- 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
- Once Noridian has completed review of the application, a Recommendation for Approval letter is sent to the State. Below are the time frames in which Noridian has to review the application.
Application Type | Processing Time |
---|---|
PECOS | On average, it can take 45 calendar days before application is sent to the state and CMS for approval |
Paper | On average, it can take 60 calendar days before application is sent to the state and CMS for approval |
- After receiving the tie-in notice, Noridian will have the following time frames to complete the application.
- If a site visit is needed, Noridian will have 45 days to complete the application
- If a site visit is not needed, Noridian will have 21 days to complete the application
Last Updated Wed, 05 Jan 2022 16:08:58 +0000