Harvard Pilgrim regularly reviews our payment policies to ensure that coding and reimbursement information is captured as completely and accurately as possible. Based on a recent review, we have made corresponding updates that apply to both the commercial Skilled Nursing Facility and Rehabilitation Facilities/Long-Term Acute Care Hospitals payment policies.
The changes to these policies include updates to the prescription pharmaceutical exclusion lists and clarification that facilities are financially responsible for any excluded non-emergent transportation service that does not have proper authorization. Additionally, KCI wound vacuums are no longer an exclusion to the per diem rate; all wound vacuums are considered included in the all-inclusive per diem rate, and the policies have been updated to reflect this.
For more information, refer to the updated commercial Skilled Nursing Facility and Rehabilitation Facilities/Long-Term Acute Care Hospitals payment policies. If you have any further questions, please contact the Provider Service Center at 1-800-708-4414, or contact your contract manager.