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Fast facts: Skilled nursing facility (SNF) helpful hints
Last Modified: 6/2/2025
Location: FL, PR, USVI
Business: Part A, Part B
The Comprehensive Error Rate Testing (CERT) review contractor (RC) randomly selects a statistically valid sample of Medicare Fee-for-Service (FFS) claims and reviews those claims for payment errors. The CERT program considers any payment that should not have been made or that was paid at an incorrect amount (including both overpayments and underpayments) to be an improper payment.
In an effort to lower the SNF improper payment rate, we are committed to educating the provider community about proper billing.
For this month’s CERT fast facts, we are sharing some helpful hints to avoid common SNF errors:
• The patient must have a supporting 3-day inpatient hospital stay or meet the requirements to waive the 3-day qualifying stay.
• The patient must have a need for daily skilled nursing or rehabilitation services:
• Medicare Part A covers Medicare-certified SNF skilled care. Skilled care is nursing or other rehabilitative services, provided according to physician orders, that:
• Require skills of qualified technical or professional health personnel, like:
• Registered nurses
• Licensed practical or vocational nurses
• Physical therapists
• Occupational therapists
• Speech-language pathologists or audiologists
• Skilled nursing or skilled rehabilitation personnel, or others under their general supervision, provide:
• Supervision requiring initial direction and periodic inspection of the actual activity
• Services that an assistant performs when a supervisor isn’t always physically present or at the location
We consider a service skilled if, because of its complexity, you can only perform it safely and effectively by, or under the supervision of, skilled nursing or skilled rehabilitation personnel.
Providers must submit documentation timely upon request from CERT/MAC.
Certifications and Recertifications must be completed and signed timely by the physician and submitted upon request. Delayed certifications must provide documentation to support the delay.
All signatures must be legible and meet Medicare signature requirements.
Minimum Data Set (MDS) completion:
• To take credit for an IV, the patient must currently, or withing the 7-day look back period, have/had an IV and is receiving medications or fluids intravenously.
• To take credit for Malnutrition, there must be supporting documentation from the physician or physician agreement with the dietician assessment.
• To take credit for shortness of breath while lying flat, the supporting documentation must be in the medical record.
Resources:
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.