With the August publication of the skilled nursing facility (SNF) PPS and consolidated billing final rule for fiscal year 2009, CMS finally ended more than one year of confusion regarding when SNFs can bill the Medicare Part A default rate if a PPS MDS assessment hasn’t been completed and accepted into the state database, says Rena R. Shephard, MHA, RN, RAC-MT, C-NE, founding chair and executive editor of the AmericanAssociation of Nurse Assessment Coordinators and president of RRS Healthcare Consulting Services in San Diego.