No changes to skilled nursing facility payments with CMS's Oct. 1 changes

On October 1, 2019, The Centers for Medicare and Medicaid Services (CMS) is changing their payment system for skilled nursing facilities for original Medicare. Priority Health will not be making changes at this time and will continue to pay skilled nursing according to our current process and payment rates for all products.

Clarification: 09/17/2019

How should SNFs bill Priority Health beginning Oct. 1?

Skilled Nursing Facilities (SNFs) should submit their Medicare claims to Priority Health following CMS guidelines for the new Patient Driven Payment Model (PDPM), including the five (5) day and discharge MDS assessments. SNFs should also continue to bill the appropriate tier charge line that we currently use to drive reimbursement. Report tier levels I-IV with revenue codes 0191-0194 to indicate the level of nursing care provided. Level I is the lowest tier, and level IV is the highest.

We're not changing our payment methodology

Per-diem methodology and payment rates remain the same. See our fee schedules at