What would happen if the interrupted stay criteria was met, but the resident came back from the hospital with a new diagnosis?



In order to utilize Medicare benefits, even if the criteria of the Interrupted Stay Policy have been met, the resident must first meet all Original Part A technical and level of care requirements. The Medicare Benefit Policy Manual, Chapter 8 states that the reason for skilled care must be for services “rendered for a condition for which the patient received inpatient hospital services or for a condition that arose while receiving care in a SNF for a condition for which he received inpatient hospital services.” It seems this is a case in which the resident has a new condition that arose while receiving care in the SNF related to the condition treated in the qualifying hospital stay. The interdisciplinary team would need to determine whether or not the patient has undergone a clinical change that would warrant an Interim Payment Assessment (IPA).

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

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