US · guidance
CMS Pub. 100-04, ch. 6, § 40.8.2
Billing When Qualifying Stay or Transfer Criteria are Not Met
SNF providers are required to submit claims to Medicare for beneficiaries that receive a
skilled level of care. This includes beneficiaries that do not meet the qualifying stay or
transfer criteria. Although these claims will not be paid by Medicare, providers must
submit these claims as covered in order to extend existing beneficiary spells of illness in
CWF. A prior qualifying hospital stay (occurrence span code 70) would not be
applicable and shall not be included with these claims. This will allow Medicare systems
to deny the claim for the appropriate reason.
Note: This instruction includes beneficiaries that were previously admitted for skilled
care then subsequently drop to non-skilled for greater than 30 days and then require
skilled care again but do not have a new qualifying hospital stay.
History
(Rev. 1618, Issued: 10-24-08, Effective: 04-01-09; Implementation: 04-06-09)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
43c48e0880faaf14a07f49534230e6ae8725a0d6097474ea662edc83cd0841e1
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