If the resident was discharged to a Medicare-participating provider, then the SNF cannot bill the RUG rate or anything else for that day.
Here is the regulation that covers the determination of whether the day can be billed as a utilization day:
<<QUOTE
Medicare Claims Processing Manual
Chapter 6 - SNF Inpatient Part A Billing
40.3.5 - Determine Utilization on Day of Discharge, Death, or Day Beginning a Leave of Absence
(Rev. 1, 10-01-03)
SNF-517.6.B, A3-3103.4
Generally, the day of discharge, death, or a day on which a patient begins a leave of absence, is not counted as a utilization day. (See the Medicare Benefit Policy Manual, Chapter 3, "Duration of Covered Inpatient Services.") This is true even where one of these events occurs on a patient's first day of entitlement or the first day of a provider's participation in the Medicare program. In addition, a benefit period may begin with a stay in a hospital or SNF, on that day.
The exception to the general rule of not charging a utilization day for the day of discharge, death, or day beginning a leave of absence is where the patient is admitted with the expectation that he will remain overnight but is discharged, dies, or is transferred to a nonparticipating provider or a nonparticipating distinct part of the same provider before midnight of the same day. In these instances, such a day counts as a utilization day. This exception includes the situation where the beneficiary was admitted (with the expectation that he would remain overnight) on either the first day of his entitlement or the provider's first day of participation, and on the same day he was discharged, died, or transferred to a nonparticipating provider.
Payment is not made under PPS unless a covered day can be billed. Also, if no-payment is possible under PPS, billing is not allowed for ancillary services. Ancillary charges for these days have been included in the PPS rates for days that can be billed.
>>ENDQUOTE
And this describes the use of the default rate - from Medicare's Medlearn site at http://cms.hhs.gov/medlearn/SNFFRManual.pdf
"Reporting the Assessment Reference Date
(ARD) on the Claim
â Each assessment must have an ARD (if no
assessment was completed, bill the claim with
the default code if covered care was provided)" (p. 36)
"Billing the default code signifies that the SNF
considers the resident to be at a skilled level of
care, but no assessment was completed to
classify him/her into a RUG III group" (p. 45)
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: ff-up question
Date: 1/10/04 7:43:10 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Somebody sent a question regarding a medicare resident that was admitted at 3:00 pm and was discharged at 10:00 pm the same date, and the question was, does she need to do a 5 day asmnt although she was not there over midnight?
I am interested to the answer too. Rena, if you are there, can you give your input about this and we want to know the regulations too.
thanks.
