It serves as a critical guide for understanding what services Medicare will cover, for which patients, and under what circumstances, directly impacting a facility’s ability to receive accurate and timely reimbursement. Skilled nursing facility staff responsible for billing, coding, care planning, and utilization review must be intimately familiar with this manual to ensure compliance and financial viability.
The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and state survey agencies as a guide to administer Medicare coverage.
The Medicare Benefit Policy Manual includes detailed information regarding day-to-day operating instructions, policies and procedures for Medicare, which are based on government statutes and regulations.
Medicare Benefit Policy Manual Chapters cover Medicare rules and regulation specific to each practice setting:
Chapter 8 – Coverage of Extended Care (SNF) Services Under Hospital Insurance
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
