CMS Updates SNF Medicare Provider Compliance Guidance to Prevent Claim Denials

The Centers for Medicare and Medicaid Services (CMS) updated its Medicare Compliance Tips for Skilled Nursing Facility 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%, with a projected improper payment amount of $4.8 billion. This is compared to an all-provider error rate of 7.4%.  

Notably, most denials were not related to the necessity of the care furnished; they were due to correctable documentation issues. Specifically, CMS stated: “For the 2023 reporting period, insufficient documentation accounted for 79.1% of improper payment rates for SNF inpatient services, while no documentation (0.2%), incorrect coding (1.2%), medical necessity (0.2%), and other errors (19.4%) caused other improper payments.” 

The resource also contains information on the areas the agency has identified as commonly leading to SNF Medicare Part A claim adjustments or denials. SNF clinical employees and billers may find it helpful to review this guidance.