Inpatient Skilled Nursing Facility Denials

Submitted by Matthew.Gregor… on Mon, 11/04/2019 - 07:43
Title
Inpatient Skilled Nursing Facility Denials
Date

According to the 2015 Comprehensive Error Rate Testing (CERT) Report, the denial rate for Skilled Nursing Facilities (SNFs) increased from 6.9% in 2014 to 11% in 2015 due to missing or incomplete certification/recertification:

  • Statement must contain need for skilled services that can only be provided in SNF/swing-bed on a daily basis for a condition patient was treated for in prior hospital stay
  • Must include physician’s dated signature (printed name if signature is illegible)

In addition, recertifications should include:

  • Expected length of stay
  • Explanation if continued need for services is for a condition that arose after SNF admission
  • Any plans for home care

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