CMS Updates SNF Billing Reference

(May 27, 2025) The Centers for Medicare and Medicaid Services (CMS) has made some updates to their Skilled Nursing Facility (SNF) Billing Reference to clarify the policy for prescription drug billing when a nursing home resident is in a Part A stay. The guidance is prompted in part by an audit done by the Office of Inspector General that found Medicare Drug Plans (i.e., Part D) were inappropriately billed for a number of drug claims covered by Part A. Medicare Part A covers drugs and biologicals ordinarily provided by SNFs for the patient’s care and treatment during a Part A stay as well as a limited supply of drugs to use outside a SNF if it is medically necessary to help a patient leave the facility. Drugs prescribed for a Part D-enrolled patient are not covered by Part D if Part A or B can pay for them. Along with clarification on this issue, the SNF Billing Reference educational tool is a helpful reference for various SNF Medicare billing questions.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841