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Skilled Nursing Facility 3-Day Rule Billing

This revised Product comprises Subregulatory Guidance for the Skilled Nursing Facility 3-day rule billing requirement, and its content is based on publicly available content within the Social Security Act, Section 1861, Part E at https://www.ssa.gov/OP_Home/ssact/title18/1861.htm#act-1861-i, Electronic Code of Federal Regulations, Part 409 at https://www.ecfr.gov/cgi-bin/text-idx?SID=db85d7cbc7b28cb756e2abcae3138bb3&mc=true&node=pt42.2.409&rgn=div5#se42.2.409_130, Social Security Act, Section 1812 at https://www.ssa.gov/OP_Home/ssact/title18/1812.htm#act-1812-f, https://www.cms.gov/files/document/snf-abn-cms-10055-fillable-pdf.pdf, and Section 1870 at https://www.ssa.gov/OP_Home/ssact/title18/1870.htm. CMS policy or operation subject matter experts also reviewed/cleared this product. The fact sheet educates providers about the 3-day rule and how it affects payment and how hospitals should correctly communicate the number of inpatient days to skilled nursing facilities and patients (or their representatives). The 3-day rule requires the patient have a medically necessary 3-day-consective inpatient hospital stay to qualify for Skilled Nursing Facility (SNF) extended care services coverage.

Download the Guidance Document

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: March 28, 2024

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.