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Questions concerning the process of requesting exceptions from the skilled nursing facility cost limits.
Health Care Law Newsletter
|September 5, 1995
Summary
Skilled Nursing Facilities (SNFs) should carefully review new Provider Reimbursement Manual (PRM) rules for cost limit exceptions. While the PRM offers guidance, SNFs must creatively justify atypical costs to avoid procedural pitfalls.
Area of Science:
- Healthcare Administration
- Reimbursement Policy
- Financial Management in Healthcare
Background:
- Skilled Nursing Facilities (SNFs) operate under cost limits that necessitate exceptions for atypical financial circumstances.
- The Provider Reimbursement Manual (PRM) outlines procedures for requesting these exceptions.
- Navigating PRM provisions can be complex, impacting SNFs' ability to secure necessary funding.
Purpose of the Study:
- To analyze the implications of new PRM provisions on SNF cost limit exception requests.
- To provide strategic guidance for SNFs in preparing and submitting effective exception requests.
- To identify potential challenges and best practices for SNFs navigating the revised PRM.
Main Methods:
- Review of the latest PRM sections pertaining to cost limit exceptions.
- Analysis of procedural requirements and guidance provided within the PRM.
- Development of strategic recommendations for SNF financial and administrative staff.
Main Results:
- New PRM provisions offer structured guidance but introduce increased rigidity.
- The process presents potential procedural challenges for SNFs not fully prepared.
- Creative justification of atypical costs is crucial for successful exception requests.
Conclusions:
- SNFs must thoroughly understand PRM requirements for cost limit exceptions.
- Strategic and creative presentation of facility-specific cost data is essential.
- Proactive engagement with PRM guidelines and intermediary submissions is advised for SNFs.