Ending a Benefit Period

40.7 - Ending a Benefit Period (Rev. 930, Issued: 04-28-06, Effective: 10-01-06, Implementation: 10-02-06) A benefit period ends 60 days after the beneficiary has ceased to be an inpatient of a hospital and has not received inpatient skilled care in a SNF during the same 60-day period. When the SNF resident's health has improved to the point where he or she no longer needs or receives the level of skilled care required for Part A coverage, the SNF must bill one of the two following scenarios: 1. For the resident that leaves the Medicare-certified SNF or DPU: a. Submit a final discharge bill, and b. Any services rendered after the discharge and billed by the SNF should be submitted on a 23x. 2. For the resident that remains in the Medicare-certified SNF or DPU after the skilled level of care has ended: a. Submit the last skilled care claim with an occurrence code 22 to indicate the date active care ended. i.e., date covered SNF level of care ended, and patient status code 30 to indicate the patient is still a resident in the Medicare-certified SNF or DPU; b. Any Part B covered services rendered and billed by the SNF after the skilled care ended should be submitted on a 22x; and c. All therapies must be billed by the SNF on the 22x. For additional instructions on ending a benefit period go to the Medicare General Information, Eligibility, and Entitlement Manual, Chapter 3, §10.4.2.