Medicare Compliance & Reimbursement

Expect the 'practical matter' requirement to be a bigger focus, says expert. Reviewing the Medicare coverage rules for skilled nursing facility (SNF) care can be one of the best moves you can make to protect your facility's bottom line. In a nutshell: "There are basically three requirements for patients who have Part A," says Victor Kintz, MBA, CHC, LNHA, RAC-CT, CCA, managing director of operations with the Polaris Group in Tampa, Fla. 1. A qualifying inpatient hospital stay that covers three midnights. Stays that turn out to include observation days can throw a monkey wrench in this technical requirement. So as part of "due diligence," the facility should verify prior to admission that the beneficiary's hospital days are, in fact, "inpatient," says Kintz. 2. The "practical matter" requirement. This means that "for a variety of reasons including safety," the beneficiary as a "practical matter" needs to receive the services as [...]