SNF Consolidated Billing Made Easy: What Every Administrator Needs to Know in 2026

Are you confident that every service billed from your SNF is correctly classified under Medicare Part A?

With 2026 bringing new exclusion codes, updated payment rates, and stricter reporting standards, even minor mistakes can lead to denied claims and lost revenue.

How can administrators simplify this process and stay fully compliant?

This blog breaks down SNF consolidated billing into clear, actionable steps to help facilities manage claims efficiently and confidently.

Overview of SNF Consolidated Billing

SNF consolidated billing is a Medicare payment model that requires skilled nursing facilities to submit a single claim for most services provided during a Medicare Part A covered stay. Instead of allowing individual providers to bill Medicare separately, this system places billing responsibility on the SNF, even when services are delivered by outside providers.

In fact, consolidated billing aligns with the SNF Prospective Payment System by bundling the cost of most services into the daily per-diem rate. This simplifies Medicare payments while requiring facilities to manage service tracking and claim accuracy closely.

When Consolidated Billing Applies

• Applies to residents admitted under a Medicare Part A covered SNF stay, where the facility is responsible for billing nearly all services provided during the stay
• Applies to physical, occupational, and speech therapy services delivered during a non-covered Part B stay
• Does not apply to residents receiving long-term custodial care without an active Medicare Part A benefit

Services Included Under Consolidated Billing

• Skilled nursing and routine care services that support the resident’s treatment plan during the covered stay
• Ancillary services commonly required for resident care, such as laboratory testing, radiology, and supplies
• Therapy services that are considered part of the bundled per-diem payment under the SNF PPS

Services Excluded from Consolidated Billing

• Professional services furnished by physicians and certain non-physician practitioners
• High-cost or highly specialized services that CMS allows to be billed separately
• Specific services provided by outside suppliers that are approved for direct billing to Medicare Part B

What is New for SNF Consolidated Billing in 2026?

In 2026, CMS introduced focused updates that directly affect how skilled nursing facilities manage consolidated billing, claim submission, and reimbursement accuracy. These changes require billing workflows to be more precise, coding references to stay current, and documentation to fully support services billed under Medicare rules.

• Updated HCPCS Exclusion Codes

CMS revised the HCPCS code lists that determine which services are excluded from consolidated billing. In fact, certain services now require separate billing under Medicare Part B, whereas others must remain bundled within the SNF claim. Accurate code selection and timely system updates are essential to prevent claim denials, delayed payments, or revenue loss.

• Medicare Part A Payment Rate Changes

Medicare Part A payment rates under the SNF PPS increased for FY 2026, directly affecting per-diem reimbursement calculations. However, the final payment amount depends on the correct submission of the claim and compliance with program requirements. Billing teams must ensure claims reflect accurate dates of service, covered days, and required modifiers to avoid underpayments.

• Quality Reporting Program (QRP) Updates

CMS updated the SNF Quality Reporting Program by removing specific standardized patient assessment elements from the MDS. These changes affect how supporting documentation is captured and reported. Therefore, proper alignment between clinical records and billing data is necessary to avoid payment reductions tied to incomplete or inaccurate reporting.

• Value-Based Purchasing (VBP) Program Changes

The SNF VBP Program introduced revisions to its scoring methodology that influence payment adjustments. Billing accuracy and timely reporting are key to ensuring performance data is accurately reflected. As a result, close monitoring of quality measures helps prevent discrepancies that can negatively affect incentive payments.

• Ownership and Control Disclosure Requirements

CMS expanded ownership and control disclosure requirements through the CMS-855A enrollment process. In fact, complete and accurate reporting is required to maintain active billing privileges. Any missing or incorrect information can result in enrollment delays, claim rejections, or increased audit risk.

Administrator Action Checklist for 2026

To stay aligned with the 2026 consolidated billing requirements, administrators must take a structured and methodical approach to updating billing operations. These actions support accurate claim submission, reduce compliance risk, and help facilities maintain predictable reimbursement throughout the year.

• Updating Billing Systems with Revised Exclusion Lists

Billing systems should be updated to reflect the latest HCPCS exclusion codes released for 2026. In fact, facilities can correctly identify services that must be billed separately and reduce the risk of improper bundling that leads to claim rejections or payment delays by keeping code libraries up to date. Routine system validation also helps ensure updates are applied consistently across all billing workflows.

• Aligning Documentation with Quality and Payment Rules

Clinical records and assessment data must consistently support the services billed to Medicare. When documentation aligns with current quality reporting and payment requirements, claims processing becomes smoother, and facilities are better protected from payment reductions tied to reporting gaps. Standardized documentation practices further improve accuracy across departments.

• Coordinating Billing Responsibilities with External Providers

Clear billing workflows should be established with outside providers who furnish excluded services. In fact, claims are directed to the appropriate payer when responsibilities are clearly defined and communicated, which helps avoid duplicate billing, disputes, and unnecessary delays in reimbursement. Also, written agreements and regular communication can reinforce consistency.

• Preparing for Audits and Compliance Reviews

Regular internal reviews of claims and supporting documentation help identify issues before they escalate. In fact, facilities can reduce audit exposure and maintain stronger compliance controls throughout the billing cycle by proactively monitoring and promptly correcting issues. Ongoing audit readiness also supports faster responses to external review requests.

• Meeting CMS Ownership Reporting Deadlines

Ownership and control information must be complete, accurate, and submitted within required timeframes. Timely reporting supports uninterrupted billing privileges and helps prevent claim denials or increased scrutiny related to enrollment compliance. In fact, periodic verification of enrollment records helps avoid last-minute compliance issues.

Conclusion

SNF consolidated billing in 2026 requires a disciplined approach that balances regulatory compliance with operational efficiency. As CMS continues to refine payment models and oversight requirements, facilities must focus on maintaining clear billing workflows and consistent coordination across departments and external partners. In fact, strong internal controls and proactive monitoring help reduce errors, improve claim turnaround times, and support stable cash flow.

Furthermore, working with an experienced outsourcing partner such as 24/7 Medical Billing Services can further simplify consolidated billing management. Their expertise in Medicare billing, keeping up with CMS updates, and ensuring compliance with consolidated billing requirements helps facilities reduce administrative burden. With the proper outsourcing support, SNFs can achieve smoother billing cycles, optimize revenue, and maintain full compliance with the 2026 guidelines.

FAQs

Can SNFs bill separately for over-the-counter medications?

Certain non-covered items may be billed outside the consolidated claim if CMS allows it.

Are telehealth services included in consolidated billing?

Telehealth visits are generally excluded and billed separately under Medicare Part B.

Do excluded lab tests need prior authorization?

Some high-cost or specialized lab tests may require separate authorization when billed to Part B.

Are ambulance transport services bundled in SNF claims?

Most ambulance services are excluded and billed separately to Medicare Part B.