CMS Updates SNF Medicare Provider Compliance Guidance Resource to Prevent Claim Denials

The Centers for Medicare and Medicaid Services (CMS) announced in its weekly MLNConnects weekly newsletter that the agency has updated its Medicare Compliance Tips for Skilled Nursing Facility (SNF) Services resource. In the update, CMS notes that according to the 2023 Medicare Fee-for-Service Supplemental Improper Payment Data​, the improper payment rate for SNF inpatient Medicare Part A claims was 14.9 percent, with a projected improper payment amount of $4.8 billion. This is compared to an all-provider error rate of 7.4 percent.  

Notably, most denials were not related to the necessity of the care furnished, but due to correctable documentation issues. Specifically, CMS stated: 

The compliance guidance resource also contains information on areas of particular focus the agency has identified that commonly lead to SNF Medicare Part A claim adjustments or denials. SNF clinical and billers may find it helpful to review this guidance.