Billing When Qualifying Stay or Transfer Criteria are Not Met

40.8.2 - Billing When Qualifying Stay or Transfer Criteria are Not Met (Rev. 1618, Issued: 10-24-08, Effective: 04-01-09; Implementation: 04-06-09) 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.