Skilled Nursing Facility (SNF) eCBR

Published 04/08/2023

This electronic Comparative Billing Report (eCBR) focuses on providers that submit claims for patients receiving care in Skilled Nursing Facilities (SNFs). 

For your personalized SNF results log on to eServices

eCBR information is one of the many tools used by Palmetto GBA to assist individual providers in identifying variation and improving performance. Becoming proactive in addressing potential billing issues and performing internal audits will help ensure you are in compliance with Medicare guidelines.

Overview of Skilled Nursing Facilities (SNFs)

A SNF provides inpatient skilled nursing care and related services to patients who require medical, nursing or rehabilitative services but does not provide the level of care or treatment available in a hospital. This is a level of care that requires the daily involvement of skilled nursing or rehabilitation staff. Examples of skilled nursing facility care include intravenous injections and physical therapy. The need for custodial care such as assistance with activities of daily living, like bathing and dressing cannot qualify the patient for Medicare coverage in a skilled nursing facility. However, if the patient qualifies for coverage based on their need for skilled nursing or rehabilitation, by meeting all requirements Medicare will cover all care needs in the facility, including assistance with activities of daily living.

Documentation must comply with all legal/regulatory requirements applicable to Medicare claims. CMS outlines its minimal documentation requirement in the Medicare Benefit Policy Manual Publication, 100-02, Chapter 15 (PDF), Section 220.3.

CMS works to eliminate improper payments in the Medicare Program and protect the Medicare Trust Fund, as well as beneficiaries from medically unnecessary services or supplies and their associated costs. CMS calculates a national Medicare fee-for-service (FFS) improper payment rate and improper payment rates by claim type and publishes the review results annually.

Methods

The metrics reviewed in this eCBR are the proportion of billing for claims rejected for rejection code C7010 vs all SNF billed claims for comparisons done to peers within the state and jurisdiction. This report is an analysis of Medicare Part A claims extracted from the Palmetto GBA data warehouse. The analysis shows the portions of your billing at each level compared to your peers in Jurisdictions J/M.

Sample eCBR Lookup Screen View

Resources

  • Three-Day Prior Hospitalization Requirement for Skilled Nursing Facility (SNF) Services (JJ Part A, JM Part A)
  • Medicare Benefit Policy Manual, Chapter 8 (PDF), Coverage of Extended Care (SNF) Services 
  • Medicare Claims Processing Manual, Chapter 6 (PDF), SNF Inpatient Part A Billing and SNF Consolidated Billing
  • Skilled Nursing Facility (SNF) Checklist (PDF)
  • Reason Code C7010 Job Aid (PDF)
  • Reason Code C7010 Module (JJ Part A, JM Part A)

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