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Issue Number - Name
0004 - Medical Necessity and Coding SNF Review
Review Type
Complex
Claim Type
SNF
Region and State
RAC 1-4
All States
Date Approved
2017-02-01

Description

Reasonable and Necessary Requirements and Coding Requirements:Documentation will be reviewed to determine if SNF Stay meets Medicare coverage criteria.

Affected Codes

Applicable Policy References

  • 42 Code of Federal Regulations, 409.30-409.36
  • 42 Code of Federal Regulations, 424.20
  • 42 Code of Federal Regulations, 483.20
  • CMS Pub. 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 4, 40.4-40.5
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 6, 6.1, and 6.3
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 8, 20-40
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 220.1.3