Can a provider bill a skilled nursing facility (SNF) or swing bed (SB) claim if the patient does not have a qualifying hospital stay?

Answer: Skilled nursing facility (SNF) and swing bed (SB) providers must submit either a qualifying hospital stay or an appropriate condition code for bypassing the qualifying stay, if applicable, on all claims including initial and subsequent claims that are submitted as covered. This is applicable for submitted bill types 21x (SNF inpatient) and 18x (SB inpatient). This also includes all covered claims (i.e., claims submitted for benefits exhaust denials). Covered claims submitted on 21x and 18x bill types that do not contain a qualifying hospital stay (using occurrence span code 70 with the qualifying hospital stay dates) or an appropriate condition code indicating why a qualifying hospital stay is not applicable will be denied.


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