Re: Midnight Rule

[Caralyn Davis]

CMS pulls out SNF PPS final rules and posts them at http://www.cms.hhs.gov/providers/snfpps/snfpps_pubs.asp#fr. Of course, you can also search for them at the Government Printing Office web site: http://www.gpo.gov   Also, the following potentially useful sections are excerpted from chapter 3 of the Benefity Policy Manual at http://www.cms.hhs.gov/manuals/102_policy/bp102c03.pdf and chapter 6 of the claims processing manual at http://www.cms.hhs.gov/manuals/104_claims/clm104c06.pdf   BPM, CHAPTER 3 20.1 - Counting Inpatient Days (Rev. 1, 10-01-03) A3-3103.1, A3-3104.3, A3-3135.1, HO-217.3, HO-216.1, SNF-242.1 The number of days of care charged to a beneficiary for inpatient hospital or skilled nursing facility (SNF) care services is always in units of full days. A day begins at midnight and ends 24 hours later. The midnight-to-midnight method is to be used in counting days of care for Medicare reporting purposes even if the hospital or SNF uses a different definition of day for statistical or other purposes. A part of a day, including the day of admission and day on which a patient returns from leave of absence, counts as a full day. However, the day of discharge, death, or a day on which a patient begins a leave of absence is not counted as a day unless discharge or death occur on the day of admission. If admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one inpatient day. Charges for ancillary services on the day of discharge or death or the day on which a patient begins a leave of absence are covered.       CPM, CHAPTER 6 40.3.4 - Day of Discharge, Death, or Leave of Absence (Rev. 1, 10-01-03) SNF-517.6, SNF-515.4 (transmittal 368) The beneficiary is considered discharged from the SNF when any of the following occur: �The beneficiary is admitted as an inpatient to a Medicare participating hospital or critical access hospital or admitted as a resident to another SNF. Even if the beneficiary returns to the SNF by midnight of the same day, the beneficiary is considered discharged, and the admitting hospital or critical access hospital is responsible for billing. This is because these settings represent situations in which the admitting facility has assumed responsibility for the beneficiary�s comprehensive health care needs. The SNF should submit a discharge bill, and if the patient is readmitted to the SNF, the SNF should submit a new bill (TOB 211). Medicare systems are set up so that the SNF need not submit a discharge bill when the situation is that the beneficiary (who leaves the SNF and then returns by midnight of the same day) receives outpatient services from a Medicare participating hospital, CAH, or other appropriate provider during his/her absence. Edits allow hospitals and CAHs to bill for these services for a Part A PPS stay. Receipt of outpatient services from another provider does not normally result in SNF discharge. Bills for excluded services (identified in �20 of this chapter) rendered by participating hospitals, CAHs, or other appropriate providers may be paid to the rendering provider in addition to the Part A PPS payment made to the SNF. Other outpatient services furnished to a resident in a Part A PPS stay by another provider/supplier must be billed by the SNF. Home health or outpatient services provided during a leave of absence do not affect the leave and no discharge bill is required. �Home health services are not payable unless the patient is confined to his home, and under Medicare regulations a SNF cannot qualify as a home. Where the beneficiary receives services from a home health agency, the home health agency is responsible for billing. �The beneficiary is formally discharged or otherwise departs for reasons other than described in the bullets above. However, if the beneficiary is readmitted or returns by midnight of the same day, he is not considered discharged and the SNF is responsible for billing for services during the period of absence, unless such services are otherwise excluded from Part A PPS payment or are excluded from Medicare coverage. In this context, a patient "day" begins at 12:01 a.m. and ends the following midnight, so that the phrase "by midnight of the same day" refers to the midnight that immediately follows the actual moment of departure from the SNF, rather than the midnight that immediately precedes it. NOTE: This instruction only applies to Medicare fee-for-service beneficiaries in a participating SNF.     ----- Original Message ----- From: Winona M. Phelps To: '[EMAIL PROTECTED]' Sent: Thursday, March 11, 2004 11:44 AM Subject: RE: Midnight Rule Hi.  The Final Rule in Federal Register/Vol. 64, No. 146 has the explanation on page 41658.  The RAI Manual covers this in Chapter 2, page 23.  I used to have the web site marked for this part of the Final Rule but guess I have lost it.  All I can find on line is the second part which starts on page 41684.  If anyone has the link I sure would appreciate having it again. Thanks, Winona Phelps, RN   -----Original Message----- From: Infante, Marie [mailto:[EMAIL PROTECTED] Sent: Thursday, March 11, 2004 8:06 AM To: [EMAIL PROTECTED] Subject: Midnight Rule Can some please point me to the authoritative CMS source document on the Midnight Rule...Thanks.  Marie Infante   STATEMENT OF CONFIDENTIALITY: The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the intended recipient, please notify Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. immediately at either (617) 542-6000 or at [EMAIL PROTECTED], and destroy all copies of this message and any attachments.