On March 13, 2020, because of the Public Health Emergency, waivers and changes were made to the Social Security Act that became effective and retroactive to March 1, 2020.
The intent of this blanket waiver, during times of Public Health Emergency, is to allow more flexibility for Skilled Nursing Facilities (SNFs), hospitals and patients to provide the best opportunities for care of the larger population. The transfer of patients from the Hospitals to a SNF opens hospital beds for others.
Harmony Healthcare International (HHI) continues to receive questions on the practical application of the waivers. Below are the top 4 things to know.
1. Under the blanket COVID waiver, patients can be admitted to a SNF without having reached the requirements for:
- three-night hospital stay,
- spell of wellness or
- new benefit period.
2. The attached Medicare Part A Certification Form needs to be completed for every Medicare Part A patient. This is a mandatory condition of payment. (Please see download).
3. Business offices will need to identify these clients when billing Medicare Part A using certain condition codes and modifiers.
- Disaster Related: The “DR” (disaster related) condition code is used when services billed are related to the emergency for institutional billing.
- Catastrophe/Disaster Related: The “CR” (catastrophe/disaster related) modifier is utilized for Medicare Part B billing, both institutional and non-institutional.
4. Skilled Nursing Facilities (SNFs) should not deny patient admissions to their facility solely on the bases of COVID-19 diagnosis or exposure. Instead, facilities need to assess the conditions of their current population, the community needs, their ability to care for these patients along with local hospital capacities. Facilities are encouraged to be proactive and always ready for a surge of positive test COVID-19 patient admissions to protect the health, safety and well-being of their patients and staff.
This waiver will make it easier for hospitals to open or keep open beds for those that are sicker and require more complex medical care.
As defined in the Social Security Act, section 1135 and section 1812(F):
“Waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of Skilled Nursing Facilities (SNFs) services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities).”
Harmony Healthcare International (HHI) is available to help you proactively case manage your Medicare Part A caseload. The HHI team can perform daily, remote medical record reviews and provide your staff with the knowledge, tools, and research to effectively skill, document and code the documents necessary to bill for services rendered. If you are interested in HHI's medical record review services, click below to fill out a form and request an introductory phone call.
Click below to download the HHI Medicare Part A Certification Form.
Harmony Healthcare International (HHI) is hosting our 9th Annual Long-Term & Post-Acute Care (LTPAC) Interdisciplinary Symposium Thursday, October 21st, and Friday, October 22nd, 2021 at the Encore Boston Harbor resort and casino. Click below to register and for more information!