Under new PDPM rules and the interrupted stay policy, a SNF PPS Discharge would not be completed if the resident returned within the 3-day interruption window. Interrupted Stay Policy: The Interrupted Stay Policy is being introduced by CMS in conjunction with the Patient Driven Payment Model. For example, the new Interrupted Stay Policy adds a whole new critical thinking process to what has been a … Ventilator patients: Patients discharged from the LTACH assigned to an LTACH diagnosis-related group of cases requiring 96+ hours on a ventilator (MS-LTC-DRG 207) The interrupted stay policy is new and will require some attention from staff across your entire organization to assess how it will impact MDS assessment schedules and reimbursement. An interrupted stay is when an LTCH patient is discharged to an inpatient acute care hospital, an inpatient rehabilitation facility (IRF), or a skilled nursing facility (SNF), stays for a maximum specified period, then goes back to … Interrupted stays—LTCHs receive one payment for “interrupted-stay” patients. To read the article in its entirety, please login or subscribe to Case Management Monthly.. An interrupted stay occurs when a long-term acute care hospital (LTAC) transfers a Medicare patient to another facility for treatment and services … SNFs are in the final stage of preparation for Patient-Driven Payment Model (PDPM) implementation, but alongside the payment model’s introduction, new policies are being introduced that add layers of complexity that nurse assessment coordinators (NACs) must master this fall. This is an excerpt from a member only article. Critical care patients: Patients whose prior short-term acute care hospital stay included 3+ days in ICU or CCU 2. The only exception to this rule is when treatment at an inpatient acute care hospital would be grouped to a surgical DRG. Reference: CMS IOM, Pub. Inpatient rehabilitation hospitals or units that do not comply with the 60% Rule will lose the IRF payment classification and will instead be categorized as general acute care hospitals. Hospital overlapping with an IPF: When the stay is for 3 days or less, verify the IPF has added Occurrence Span Code (OSC) 74 with the associated dates of service. Multiple interrupted stays should be entered as one claim but each interrupted stay should be evaluated individually for the rule regarding the appropriate number of days at the intervening facility. If the length of stay at the receiving site of care exceeds the specified time, the return to the LTCH … Observation Stays Fact Sheetact Sheet SUPPORTED BY Medicare beneficiaries are being denied access to Medicare’s skilled nursing facility (SNF) benefit because of the way hospital stays are classified. LTACH reimbursement rate preserved for two kinds of patients: 1. E-mail; Print; RSS; Ensure proper payment from interrupted stays Case Management Monthly, July 1, 2011. Planning ahead will ensure your organization thrives under the new PDPM model come October 2019. The OBRA Discharge assessment would still be completed if the individual was admitted to the hospital or if the observation stay was >24 hours. The 60% Rule is a Medicare facility criterion that requires each IRF to discharge at least 60 percent of its patients with one of 13 qualifying conditions. The Interrupted Stay is a Medicare Part A SNF stay in which a resident is discharged from SNF care (i.e., the resident is discharged from a Medicare Part A-covered stay) and subsequently resumes SNF care in the same SNF for a Medicare Part A-covered stay during the interruption window. 100-04, Chapter 3, Section 150.9.1.2.
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