This is called the Midnight Rule, and they can leave the facility even past midnight for a pass to go either for fun with family or for a therapeutic leave. This was copied off the web at:
http://www.advanceforpac.com/common/Editorial/editorial.aspx?CC=648 Question: A Part A patient went home for a weekend therapeutic visit with her husband to determine if he could care for her. My facility administrator says Medicare will be billed for those two days, and he wants rehab to document as to how she did at home so they can count the days. I am not real sold on this approach. Answer: The facility cannot bill for the days the patient was out of the building as they were not on the census at midnight. Even if the facility was holding the bed for her return, they cannot bill Medicare. According to the SNF PPS Final Rule, G. MDS Scheduling Requirements 3. Discharge and Leave of Absence: "We received questions from other commenters on how to handle cases in which the beneficiary is out of the facility at the time of census-taking, midnight. These activities are all interrelated and have generated many questions during the initial phase of PPS implementation. There are a number of reasons why a beneficiary may leave the SNF for a ''leave of absence.'' These include a temporary home visit, a temporary therapeutic leave, or a hospital observational stay of less than 24 hours in which the beneficiary is not formally admitted to the hospital and is not discharged from the SNF. In each of these situations, there is no requirement for the SNF to complete a Discharge or a Re-Entry Tracking form. When a beneficiary goes to an acute care hospital emergency room (ER) during his or her SNF stay and is in the ER at midnight, there is an additional aspect with regard to Medicare payment. According to Medicare rules, the day preceding the midnight on which the beneficiary was absent from the facility becomes a day for which the SNF may not bill Part A of Medicare. This is known as the ''midnight rule.'' There is no way that you can document how she did at home other than in reference to the questions you ask the husband. It would be falsifying documentation for you to indicate anything other than the patient was on a therapeutic leave of absence. Hopefully, the leave was with her MD's approval and written order. You should document the results of how the husband feels he managed, and what, if anything, has changed in discharge planning because of the leave and the therapy goal achieve a safe D/C home. ----- Original Message ----- From: <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Monday, March 08, 2004 2:06 PM Subject: LOA's & Medicare > Hi, > > I've always thought if a resident was on Medicare A he/she couldn't go home for the day or even out for the afternoon with family members. Now I'm hearing he/she can as long as they are back by midnight. Has something changed and I missed it? Does any one have a web site I can access with the information? Thanks muchly! :) > > Susann Irwin, RN > MDS Coordinator > Garner, NC > /---------------------------------------------------------- > The Case Mix Discussion Group is a free service of the > American Association of Nurse Assessment Coordinators > "Committed to the Assessment Professional" > Be sure to visit the AANAC website. Accurate answers to your > questions posted to NAC News and FAQs. > For more info visit us at http://www.aanac.org > -----------------------------------------------------------/ --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.614 / Virus Database: 393 - Release Date: 3/5/2004 /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
