Introduction
The SNF Billing Rule 2026, released by the Centers for Medicare & Medicaid Services (CMS), introduces significant updates that directly impact reimbursement, documentation, and compliance for Skilled Nursing Facilities (SNFs). These rule changes are outlined in the FY 2026 SNF Prospective Payment System (PPS) Final Rule, which includes revised payment rates under the Patient-Driven Payment Model (PDPM), expanded quality reporting measures, and increased audit scrutiny.
At Reenix Excellence, we help SNFs interpret and apply these updates effectively—reducing compliance risks and protecting revenue. This article breaks down everything you need to know about the SNF Billing Rule 2026, based on verified CMS sources.
1. PDPM Rate and Case-Mix Adjustments for FY 2026
The SNF Billing Rule 2026 includes a 3.0% market basket increase for SNF payment rates. CMS also updated the wage index values and recalibrated PDPM case-mix indexes across all components: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Nursing, and Non-Therapy Ancillary (NTA).
Key Changes:
- New PDPM base rates and wage-adjusted payment tables
- Updated ICD-10-CM mappings used for clinical category assignment
- Continued exclusion of budget neutrality adjustment for FY 2026
SNFs must update their billing software and MDS processes to reflect these changes to avoid underpayments or overpayments.
2. Updated ICD-10 PDPM Mapping File
The CMS-issued ICD-10 mapping file for 2026 affects how residents are categorized under PDPM. Changes include:
- Removal of outdated or invalid codes
- Reclassification of codes to different clinical categories
- Introduction of new diagnosis codes impacting SLP and NTA scoring
Accurate diagnosis coding directly impacts PDPM reimbursement rates. Mistakes in mapping can trigger denials or improper payments.
3. Medicare Part A Documentation Requirements
The SNF Billing Rule 2026 reinforces CMS’s emphasis on proper documentation to support skilled care under Medicare Part A.
Documentation must include:
- Evidence of daily skilled services
- Clinical progress notes that reflect the need for continued care
- Physician orders and interdisciplinary team collaboration
- Objective measurement of therapy goals and outcomes
Audits are increasingly targeting facilities with vague or templated documentation. SNFs should regularly review charting practices to maintain compliance.
4. SNF Value-Based Purchasing (VBP) Program Expansion
In 2026, CMS expanded the SNF VBP Program to include new performance measures beyond hospital readmissions:
- Discharge to Community
- Medicare Spending Per Beneficiary (MSPB)
- Healthcare-Associated Infections (HAI) (claims-based)
Facilities will be scored on these metrics, and payment rates will be adjusted accordingly. Poor performance can lead to payment reductions.
SNFs should align clinical coding, therapy progress tracking, and care planning with these performance indicators.
5. Telehealth Billing in SNFs: What’s Still Allowed?
The SNF Billing update does not introduce new telehealth billing rights for SNFs. However, under the extended Consolidated Appropriations Act of 2023, physicians and NPPs may continue billing Medicare Part B for telehealth visits delivered to SNF residents until December 31, 2024.
Important Billing Rules:
- SNFs themselves cannot bill for telehealth under Part A
- Part B services must include proper POS codes (02 or 10) and modifiers (95)
Any telehealth services provided during a Part A stay must follow Consolidated Billing requirements.
6. OIG SNF Billing Compliance Focus Areas for 2026
In 2026, the Office of Inspector General (OIG) continues to monitor SNFs for billing practices that could result in improper payments.
Key Audit Risks:
- PDPM upcoding with unsupported diagnoses
- Billing for skilled care without adequate documentation
- Overuse of therapy without medical necessity
- Improper claims under SNF Consolidated Billing rules
SNFs are encouraged to perform internal audits and pre-bill claim reviews to avoid penalties.
7. State Medicaid SNF Billing Considerations
While CMS governs Medicare billing, Medicaid SNF reimbursement varies by state. In 2026, many states continue implementing:
- Case-mix adjusted payment models
- Value-based purchasing arrangements
- Increased reporting of staffing and quality data
SNFs must stay current with their state’s Medicaid bulletins to remain compliant with local rules and avoid payment interruptions.
Why Work with Reenix Excellence?
At Reenix Excellence, we provide regulation-based medical billing services designed for Skilled Nursing Facilities. Our experts track every update from CMS and OIG and apply these changes directly to your revenue cycle process.
Our SNF Billing Services Include:
- PDPM claim creation and diagnosis coding audits
- Part A and Part B billing compliance
- Pre-bill reviews aligned with Medicare documentation rules
- Consolidated Billing management
- Medicaid billing by state
- Real-time reporting and denial resolution
Partnering with Reenix Excellence means your facility can operate with confidence—compliant, audit-ready, and revenue-focused.
Top 5 FAQs About SNF Billing Rule 2026
1. What is the SNF Billing Rule 2026?
The SNF Billing Rule 2026 refers to CMS’s final rule that updates payment rates, coding guidance, and documentation standards for Skilled Nursing Facilities for fiscal year 2026.
2. How did PDPM change in the 2026 SNF billing rule?
PDPM changes in 2026 include a 3.0% rate increase, updated wage index values, and new ICD-10 mappings that affect case-mix classification and reimbursement rates.
3. What documentation is required for Medicare Part A billing in 2026?
SNFs must document daily skilled nursing or therapy needs, clinical progress, physician orders, and interdisciplinary care plans, per CMS’s Benefit Policy Manual.
4. Can SNFs bill Medicare for telehealth under the 2026 rule?
SNFs cannot directly bill Medicare Part A for telehealth. However, physicians may bill Part B for approved telehealth services delivered to SNF residents through 2024.
5. What audit risks are highlighted by OIG in 2026?
OIG is auditing SNFs for PDPM upcoding, lack of medical necessity, improper therapy billing, and billing errors under SNF Consolidated Billing.
Stay Compliant With SNF Billing Rule 2026
The SNF Billing Rule 2026 reflects CMS’s focus on payment accuracy, care quality, and proper documentation. Staying compliant requires more than just knowledge—it demands precision and proactive adaptation to CMS guidance.
Let Reenix Excellence be your trusted partner in navigating SNF billing changes. Our team helps you maintain compliance, reduce denials, and improve your revenue cycle performance.
Need Help Navigating SNF Billing Rule 2026?
Contact Reenix Excellence today for a customized consultation. We help Skilled Nursing Facilities apply CMS billing changes correctly—backed by expert support and regulatory insight.
Sources used in this article include:
- CMS Final Rule: FY 2026 SNF PPS Updates: https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf
- Medicare Benefit Policy Manual (Chapter 8): https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c08pdf.pdf
- OIG Work Plan Updates (2026): https://www.stateoig.gov/report-318
- CMS SNF VBP Program updates: https://www.aapacn.org/solution-providers/major-changes-to-snf-vbp-program-what-you-need-to-know-to-be-successful/
- CMS Telehealth Services List
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