Carriers should follow nursing facility billing policy, CMS says

Why This Topic Matters

Billing for SNF resident services can be affected by whether the stay is covered or noncovered, which affects claim routing and payment processing. Understanding the CMS policy helps reduce denials and resolve conflicts between carrier instructions and national guidance.

Article Sections

1. CMS billing policy for SNF residents beyond covered days

   Overview of the billing policy issue and the distinction between covered and noncovered SNF stays. This section frames the CMS guidance and the carrier inconsistency discussed in the article.

2. CMS program memorandum AB-01-159

   Discussion of the CMS memorandum that reiterates and clarifies aspects of SNF consolidated billing policy. This section notes the memo’s role as formal written guidance and its effective date.

3. Medicare Carriers Manual reference

   Explanation of the manual section cited as additional support for the CMS position. This section focuses on where readers are directed for further policy clarification.

4. Claims submission and payment handling for SNF services

   Summary of how different components of physician and therapy services are addressed under SNF billing policy. This section also notes the role of CMS guidance in payment routing and denial handling.