Ask the expert: Is the three-day qualifying stay going away?
Case Management Insider, November 24, 2015
Under current Medicare rules, patients can only get coverage for a stay in a skilled nursing facility (SNF) if they’ve spent three consecutive inpatient days in a hospital. If they are receiving observation services, the stay does not quality for coverage. For example, if a patient spends one day in observation and two days as inpatient, even though they’ve spent three days in the hospital the stay does not meet the three-day inpatient day stay requirement. One of our readers recently approached us after hearing rumors that this requirement may soon be a thing of the past. So we asked expert Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at Accretive Health in Chicago if the whispers are true or just wishful thinking.
Q: We are hearing that the qualifying three-day stay for coverage for a SNF stay may be going away effective January 1, 2016. Have you seen anything in writing?
A: This is totally false it would take action by Congress to abolish it completely. However, CMS did propose that the three-day requirement will be waived starting in year two of the Comprehensive Care for Joint Replacement program (which is still under review) and some pioneer accountable care organizations have been given permission to waive the requirement.
Got something you want to ask our experts? If you’ve got questions about the 2-midnight rule or any other case management topic, please e-mail them to Kelly Bilodeau at Kelly@phbphoto.com and we will have one of our experts answer it and will publish the response in an upcoming issue of Case Management Monthly.
Related Products
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Complications from immobility by body system
- Differentiate between types of wound debridement
- OB services: Coding inside and outside of the package
- Q&A: Primary, principal, and secondary diagnoses
- Nursing responsibilities for managing pain
- The consequences of an incomplete medical record
- Practice the six rights of medication administration
- CDC alert: Screen for international travel as Ebola cases increase
- E-mailed
-
- CDC alert: Screen for international travel as Ebola cases increase
- Differentiate between types of wound debridement
- Q&A: Bill blood administration the same way for inpatient and outpatient accounts
- Q&A: A second look at encephalopathy as integral to seizures/CVA
- Performing a SWOT analysis
- Leadership training for charge nurses
- Helping Charge Nurses understand their leadership role (Part 2 of 3)
- Developing a Fall-Prevention Program
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Watch for different codes for SI joint injections
- Searched