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SNF certification and recertification must be signed and timely in accordance with CMS regulations.
To meet requirements the certification or recertification statement must clearly indicate posthospital extended care services were required because of the individual's need for skilled care on a continuing basis for which he/she was receiving inpatient hospital services.
Impact of the More Stringent Review Criteria The more stringent review criteria for review of claims selected for the November 2009 report resulted in increases in error rates due to: In the past, CERT would review available documentation, including physician orders, supplier documentation, and patient billing history, then apply clinical review judgment.
Now, CERT requires medical records from the treating physician and does not review other available documentation or apply clinical review judgment.
In this manner, we will incorporate the commenters' suggestion on the timing of post-discharge delivery of information regarding billing under Part B for inpatient hospital services, consistent with our approach to delivering notices at a time when the information is most relevant. CMS predicts that more patients will be inpatients under its revised regulations as a result of its new Part B inpatient billing policies. Conclusion Despite the new regulations, observation status will remain a problem for Medicare beneficiaries who need post-acute care in a SNF. 15, 2012); in proposed rules on A-B rebilling, 78 Fed. “[W]hen the inpatient hospital stay is paid under Part B, the hospital stay remains inpatient from the time of admission and may continue to count towards qualification for skilled nursing facility coverage, and the beneficiary is liable for the Part B inpatient charges.” 78 Fed. Hospitals must submit Part B claims within one year of providing the service. Of note, CMS reports that more than 300 commenters opposed the proposal to limit rebilling under Part B to claims submitted within one calendar year of service and that only a single commenter supported that proposal. Preamble If a hospital submits a Part B claim for a patient, following the patient's discharge, the patient retains inpatient status for purposes of Medicare coverage of the subsequent SNF stay.CMS provides: the status of the beneficiaries themselves does not change from inpatient to outpatient under the Part B inpatient billing policy.Instead we look to the federal legislation and successful resolution of pending litigation brought by the Center for Medicare Advocacy which would resolve the problem of observation status for beneficiaries. CMS repeated the concern in proposed rules for the hospital prospective outpatient payment system, 77 Fed. 45155 (July 30, 2012); in final rules on the hospital prospective outpatient payment system, 77 Fed. Reg., 16632, 16634-634 (March 18, 2013); in proposed rules on time-based presumptions of inpatient status, 78 Fed. Reg.27486, 27644 (May 10, 2013); final inpatient prospective payment rules, 78 Fed.