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Did You Know? – COVID-19

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  1. FAQs issued by the Centers for Medicare & Medicaid Services (CMS):
  2. I listed the DR Condition Code on my claim and it still rejected for benefits exhaust. Why and how can I fix?

    • Due to the COVID-19 pandemic, CMS utilized its authority under section 1812(f) of the Social Security Act to waive certain Medicare requirements under the SNF PPS. Specifically, for patients who have exhausted their SNF benefits, the waiver authorizes renewed SNF coverage without first having to start a new benefit period. This waiver applies only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances.

      In cases where a patient qualifies for renewed SNF benefits under this waiver, the following impacts on typical billing and assessment processes would occur:

      1. For patients that have exhausted their 100 day SNF benefit period and have begun, but not yet completed, the process of ending the current benefit period, the patient's renewed benefit period would be treated as a new SNF stay. This means that providers would be required to complete a 5-day assessment and the variable per diem schedule would begin on Day 1.
      2. For patients that exhaust their 100 day SNF benefit period during a SNF stay and continue the SNF stay under renewed SNF benefits, the patient must be discharged from the SNF stay on the day the patient's benefits exhaust. This includes completing a PPS Discharge Assessment. The patient would then be admitted to a new SNF stay beginning on the first day of the renewed benefits. This means that providers would be required to complete a 5-day assessment and the variable per diem schedule would begin on Day 1.
      Reviewed 09/22/2021

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