SNF Demands - Service Specific Targeted Review Interim Findings - JF Part A

Summary of Findings

Findings of the 22 claims reviewed from January 1, 2025 through March 31, 2025 are as follows:

• 14 claims were denied in full with beneficiary liability for the following reasons:
  • Documentation did not support medically necessary daily skilled services were provided and a valid SNF Advanced Beneficiary Notice of Non-coverage (SNF ABN) was issued timely.
• 8 claims were denied in full with provider liability for the following reasons:
  • A SNF ABN was not issued timely or invalid.
  • No documentation was submitted/56900 denial.

The overall quarterly error rate for this service specific targeted review is 29.1%. The error rate is calculated by dividing the dollar amount of charges billed in error (minus any confirmed under-billed charges) by the total amount of charges for services medically reviewed. If you are a provider that had claims involved in the review sample and disagree with a claim determination, the normal appeal process may be followed as directed on the Noridian website under Appeals or as directed in your claim remittance advice.