Q:
My biller is requesting a HIPPS code for a Medicare resident who admitted to our SNF and then transferred to an assisted living facility on the same day. I didn’t think we could bill for the day of discharge. Please clarify.
A:
Generally, the day of discharge, death, or day on which a patient begins a leave of absence is not a billable day. However, according to Chapter 6, section 40.3.5 of the Medicare Claims Processing Manual, a patient who is admitted with the expectation that he will remain overnight but is discharged, dies, or is transferred to another, nonparticipating provider (or to a nonparticipating portion of the same provider) before the following midnight is an exception to the general rule. In such cases Medicare may be billed for the one covered day. In the situation you describe since the patient was discharged to an ALF prior to midnight on same day they were admitted, and an ALF is not a Medicare provider it is possible to bill Medicare and receive reimbursement for this one day. If at the time of admission, a 5-day MDS was opened for any day in window it is possible to more the ARD to the day of discharge and combine it with the OBRA discharge MDS. Of course, if the PPS 5-day assessment ARD was not set timely, you may bill at the default rate (ZZZZZ). Chapter 6.8 of the RAI further details use of the default rate for stays less than 8 days and there is no applicable Medicare assessment in iQIES.
Chris Calo RN, BSN, RAC-CT
MDS Consultant
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