Ask the Experts

Ask the expert: Medicare Advantage 100 days of Skilled Nursing

Q: If a beneficiary changes from one Medicare Advantage plan to another-do they automatically get 100 new days of Skilled Nursing? MAO’s do not report days paid to the Common Working file and unless the SNF informs the new plan of days paid under another plan or that the beneficiary has had previous stays, we may not know they have used days.

A:  The beneficiary only has a benefit period of 100 days per spell of illness regardless of the Medicare payer (and could be an accumulation of days between Medicare Advantage plans and traditional Medicare Part A). <per 100-01 MGIM, CH 3, §10.4.1> Although Medicare Advantage plans do not report days used, the SNF is required to report those days as indicated in the Medicare Claims Processing Manual, Chapter 6, §90.2.

SNF providers shall apply the following policies to MA beneficiaries who are admitted to a SNF:

  • Count the number of days paid by the plan as Part A days used (this IS the beneficiary’s 100 days of Medicare SNF benefits);
  • Submit a claim to the “fee for service” intermediary to subtract benefit days from the CWF records. (Note: The plans do not send claims to CWF for SNF stays). Failure to send a claim to the FI will inaccurately show days available.

Billing Requirements (for the SNF) − Submit covered claims and include a HIPPS code (use default code AAA00 if no assessment was done), room and board charges and condition code 04.

NOTE:  If the beneficiary drops his or her MA plan participation during their SNF stay, the beneficiary is entitled to coverage under Medicare FFS for the number of days available that remain out of the 100 days available under the SNF benefit