New guidance from the CMS Medicare Learning Network online publication walks through when skilled nursing facilities, working with accountable care organizations, may process some claims without first meeting certain requirements, starting in 2017.
The changes will require adjustments in billing systems and workflows for healthcare organizations that are participating in accountable care arrangements.
“Change Request 9568 allows the processing of SNF claims without having to meet the 3-day hospital stay requirement for certain designated SNFs that have a relationship with an ACO participating in the Medicare Shared Savings Program,” according to CMS. “Make sure your SNF is clear on whether or not it is eligible to participate in this initiative and that your billing staffs are aware of this change.”
Medicare’s skilled nursing benefit covers beneficiaries requiring a short-term intensive stay in a SNF for nursing and/or rehabilitation services. These beneficiaries must have had an inpatient hospital stay of at least three consecutive days to be eligible for coverage of SNF services.
CMS, however, in some cases can wave the hospital stay requirement. The agency also will reimburse certain SNFs participating in a Track 3Medicare Shared Savings ACO. The guidance is available here.
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