Harmony Healthcare Blog

Medicare Presumption of Coverage

Posted by The Harmony Team on Wed, Jun 23, 2010

Medicare Presumption of Coverage:  Under SNF PPS, beneficiaries who are admitted or readmitted directly to an SNF after a qualifying hospital stay are considered to meet the level of care requirements up to and including the assessment reference date for the 5-day assessment, when assigned to one of the Resource Utilization Groups (RUGs) that is designated as representing the required level of care.  The coverage that arises from this Medicare presumption of coverage remains in effect for as long thereafter as it continues to be supported by the facts of the beneficiary's condition and SNF care needs. 

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Topics: Medicare Presumption of Coverage

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