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If a resident discharges and returns from an interrupted stay do we start over on the Medicare certification?


If the resident qualifies for the interrupted stay, certs/recerts do NOT have to be restarted. From CMS FAQ:

13.21 How does the interrupted stay policy affect Medicare physician certification?

The existing requirements governing level of care certification and recertification timeframes are tied to a beneficiary’s SNF admission. If a beneficiary is discharged from the SNF (or from the covered Part A stay) and then resumes covered SNF care within the interruption window, the subsequent resumption would not be considered a new admission and, thus, would not trigger a new certification/recertification schedule.

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Blog by Eleisha Wilkes, RN, RAC-CTA, Clinical Consultant, Proactive Medical Review

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