SNF Wait-Listed

Definition of SNF Wait-Listed

Acute care hospitals are occasionally unable to transfer a patient from an acute bed to a skilled nursing bed because a bed is not available. In these instances, the patient's care may be downgraded to an SNF level, and the patient can be placed on a waiting list for transfer. When this occurs, HMSA considers the member to be "SNF wait-listed."

Payment Provisions

The DRG for the inpatient stay covers wait-listed days and represents payment from admission to discharge. In the case of wait-listed patients, they are not discharged, but their level of care decreases to skilled nursing level. SNF per diems are not paid for SNF wait-listed patients. Refer to Skilled Nursing Facility for more information.

Claims Filing Instructions

When a member is SNF wait-listed, submit claims using the SNF room-and-board rate instead of the acute care rate (where applicable). Code 75 with the start date and end date must be indicated in form locators 35 and 36 (Occurrence Span) of the UB-04 claim form.

Note: These claims filing instructions and benefit payment provisions do not apply to members of 65C Plus. Medicare claims processing requirements and benefit payment provisions take precedence for these plans.

Detailed Notice of Discharge

For 65C Plus members who request an immediate review of their discharge by the Quality Improvement Organization (QIO), facilities must deliver a Detailed Notice of Discharge (CMS 10066) if the member:

• Disagrees with the discharge from the inpatient acute hospital or
• Disagrees with the discharge from the acute hospital and transfer to an SNF or hospice or
• Remains in the facility, but the plan no longer intends to continue coverage of the inpatient stay. (Reasons for discontinuation of coverage include a downgrade in level of care to SNF or intermediate care.)

Effective July 2, 2007, the Detailed Notice of Discharge replaced the Notice of Discharge & Medicare Appeal Rights (NODMAR).

Revision History