How to Prevent Common Skilled Nursing Facility Denials

This article was developed to increase awareness and educate SNFs on the top errors found by our Medical Review team. The information below includes suggestions to ensure documentation requested meets Medicare regulations and that all the required documentation for review is accurate and submitted timely.

National Government Services Medical Review and Mobile Medical Review teams have noted below the top denial reasons for SNFs:

Denial Reason Code	Denial Statement	Suggestions to Prevent Future Errors
55S22	The information provided does not support the level of service as shown on the claim.	Ensure documentation submitted can validate the HIPPS code billed on the claim, and the items found on the MDS are accurately reflected in the documentation within the lookback period.
55S29	This claim was denied after review, and it was determined that the documentation needed to make payment was missing/incomplete.	Before submitting documentation for medical review, double check to ensure all requested documentation is submitted. Refer to the Notification Letter for the complete list of required documentation. Ensure the submitted documentation is for the correct beneficiary, correct dates of service, legible documentation, complete SNF ABN, and MDS is in the repository. If signatures are illegible or missing, then submit a signature log or signature attestation accordingly.
55S30/55S31	Information provided does not support the need for skilled nursing facility care.	Ensure to include all documentation that supports the need for skilled care and that care is reasonable and necessary. Ensure to include all documentation to support daily skilled care for nursing and/or therapy. Any incomplete documentation may be subject to denial if it does not cover all dates of service under review. Examples include daily nursing notes, daily therapy notes and/or logs. This documentation should support that skilled care was given to the beneficiary and that it meets the Medicare Regulations for frequency and duration.

Skilled Nursing Facility Resources

Revised 6/20/2024

Helpful Resources

Targeted Probe and Educate Manual

Helpful Resources

Targeted Probe and Educate Manual

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National Government Services, Inc.
P.O. Box 7108
Indianapolis, IN 46207-7108