SNF (Skilled Nursing Facility)
Skilled Nursing Facility
Medicare-covered short-term skilled nursing care following a qualifying hospital stay, paid under the SNF PPS using PDPM.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Acronym for
- Skilled Nursing Facility
- Primary sources
- 1
- Workspace handoff
- ask d3 →
Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CMS SNF PPS uses the Patient-Driven Payment Model (PDPM) to set per-diem rates by clinical category. Up to 100 days per benefit period with cost-sharing after day 20.
How it shows up in your practice
SNF coverage requires a qualifying 3-day inpatient hospital stay (per traditional rules; CAA flexibilities apply for certain MA plans). Physician services in SNF bill Part B with POS 31.
Sources
- CMS — Skilled Nursing Facility PPShttps://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility
Look up SNF coverage in Ask D3
Open ask d3 →Related terms
- PayerMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- BillingTwo-Midnight RuleMedicare policy that generally treats a stay spanning two midnights as appropriate for inpatient admission.
- BillingInpatient Hospital BillingFacility billing for hospitalized patients, classified using the MS-DRG system under the Acute Inpatient Prospective Payment System.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- GlossaryInpatient Hospital BillingFacility billing for hospitalized patients, classified using the MS-DRG system under the Acute Inpatient Prospective Payment System.
- GlossaryTwo-Midnight RuleMedicare policy that generally treats a stay spanning two midnights as appropriate for inpatient admission.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
- CompliancePECOS Provider Enrollment Verification (2026) — Quarterly ChecklistQuarterly PECOS provider enrollment verification workflow: who to check, the exact lookup steps, the audit log columns, and the revalidation escalation path.
- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryACA Marketplace PlanHealth plans sold through the federal or state-based health insurance marketplaces under the Affordable Care Act.
- GlossaryAdvance Explanation of Benefits (AEOB)Under the No Surprises Act, the advance benefit statement that insurers must provide to insured patients before scheduled services (implementation deferred).
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.