Why does an Intermediary need to review a Skilled Nursing Facility demand bill?
A. Your facility may determine upon admission that the level of care will be non-covered or excluded and therefore Medicare will not pay. You must advise the beneficiary that, in your opinion, Medicare will not pay for these services. If the beneficiary disagrees and requests you to submit a bill to the Intermediary, you must submit a “demand bill”. The Intermediary will determine whether the provider is incorrectly determining and advising beneficiaries and/or beneficiaries’ representatives that services are not covered by Medicare where, in fact, some or all of the services may be covered. The Intermediary also determines by review of the “demand bill” if adequate notice of non-coverage of skilled care was provided to the beneficiary and/or the beneficiaries representatives.
