medicare-snf-eligibilitylisted

Reason through skilled nursing facility (SNF) coverage before or at admission: Medicare Part A benefit-period math, the 3-day qualifying stay, Medicare Advantage authorization, Medicaid and Medicaid-pending risk, and payer coordination. Use whenever the user mentions eligibility, benefit days, qualifying stay, 3-day stay, observation vs inpatient, 30-day transfer rule, benefit period, coinsurance days, 100 days, Medicaid pending, share of cost, patient liability, prior authorization for a SNF admission, or coverage verification for a referral or admission. Produces a structured eligibility worksheet with a coverage determination, benefit-days math, risks, and open items to verify.
magicare-ai/snf-skills · ★ 1 · AI & Automation · score 75

Install: claude install-skill magicare-ai/snf-skills

# Medicare SNF Eligibility Reasoning Help SNF admissions and billing staff reason through whether a prospective admission is covered, by which payer, for how many days, and at what financial risk — BEFORE the resident is in the building. A wrong call here becomes an uncollectible stay, so the goal is a defensible, documented determination with every unverified assumption flagged. Never guess facts you don't have (dates, plan names, days used). Ask for them or list them as open items. Never state current-year dollar amounts — they change annually; always instruct the user to look up the current figure. ## Step 1: Identify the payer situation Ask (or extract from what the user provided): 1. What coverage does the patient have? Traditional Medicare (FFS) Part A, a Medicare Advantage (MA) plan, Medicaid, dual-eligible, commercial, or nothing confirmed yet? 2. Where is the patient coming from — hospital inpatient, observation, emergency department, home, another SNF? 3. Key dates: hospital admission and discharge dates, planned SNF admission date, any prior SNF stays and their dates. Route the analysis: FFS → Step 2. MA → Step 3. Medicaid or Medicaid-pending → Step 4. Multiple payers → also do Step 5. Always finish with Steps 6–7. ## Step 2: Medicare FFS Part A analysis Work through these gates IN ORDER — each one can independently kill coverage. ### Gate 1: 3-day qualifying inpatient hospital stay Medicare Part A SNF coverage requires a medically necessary I