CMS Sees Increase in Inpatient Skilled Nursing Facility Denials

According to the 2015 Comprehensive Error Rate Testing (CERT) Report released by the Centers for Medicare & Medicaid Services (CMS), the denial rate for Skilled Nursing Facilities (SNFs) increased from 6.9% in 2014 to 11% in 2015 due to missing or incomplete certification/recertification. CMS reminded that a statement must contain need for skilled services that can only be provided in SNF/swing-bed on a daily basis for a condition patient was treated for in prior hospital stay. They also noted that must include physician’s dated signature (printed name if signature is illegible).

In addition, recertifications should include:

• Expected length of stay
• Explanation if continued need for services is for a condition that arose after SNF admission
• Any plans for home care

Here are some CMS Resources to help:

• CERT: SNF Certifications and Recertifications MLN Matters® Special Edition Article
• SNF Billing Reference Fact Sheet
• Medicare Fee-For-Service 2014 Improper Payments Report, page 19
• Medicare Fee-For-Service 2015 Improper Payments Report, page 18