Re: NEED CLARIFICATION OF OPPOSING OPINIONS

[edart6]

On the responses below--from sreiterman--this refers to a same day admission/discharge--you can always bill for this day (at either the RUG determined by a 5 day assessment or at the default rate.) The day is NOT a utilization day (does not count against the 100 per spell of illness.) Here is Rena's response to this from 2002--   The following are excerpts from the Medicare SNF Manual (Pub 12). Rena 5l7.6    Determining Whether a Part of a Day is a Utilization Day.-- A.  Day of Admission.--The day of admission counts as a utilization day except in the situation where the patient was admitted with the expectation that he remain overnight but was transferred to another participating provider before midnight of the same day. In this instance, the first provider shows "l" in Item 24, Noncovered Days and "0" in Item 23, Covered Days, and does not complete Item 60, Inpatient Deductible or Item 61, Coinsurance, or make a deductible or coinsurance charge to the patient. The provider to which the patient was transferred counts the admission day as a utilization day and completes Items 60 and 61, includes the day in Item 23, and makes a deductible or coinsurance charge to the patient where applicable. Both providers may bill for accommodation and ancillary charges. This general rule applies to transfers between SNFs and between a hospital and an SNF. However, under these same circumstances, if the two providers represent an institution composed of a participating hospital and a distinct part participating SNF, the first provider cannot bill for accommodations, but may bill for ancillary charges. B - Day of Discharge, Death, or Day Beginning a Leave of Absence.-- 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 ��242ff.) 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 both situations, no payment can be made for accommodations for the day of discharge, death, or day beginning a leave of absence, but payment may be made for ancillary services provided. In addition, a spell of illness begins whether the stay was in a hospital or SNF. See �560, Item 15, Admission Date, and Item 22, Statement Covers Period, for special instructions pertaining to completion of Items 15 and 22 for these situations. 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 exception 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. 242.1    Counting Inpatient Days.--The number of days of care charged to a beneficiary for inpatient skilled nursing facility service 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 reporting days of care for Medicare reporting purposes, even if the facility uses a different definition of day for statistical or other purposes. A part of a day including the day of admission, counts as a full day. However, the day of discharge, death, or a day a patient begins a leave of absence is not counted as a day. (Charges for ancillary services on the day of discharge, death, or the day a leave of absence begins are covered.) 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. (For billing when a patient is discharged, dies, or is transferred to another facility before midnight of the day of admission, see section 516.8.)     On Wed, 14 Apr 2004 21:54:44 EDT [EMAIL PROTECTED] writes: I'm sorry, but I won't let this go. Please read both messages below and let me know what the final ruling is. I alone have 99 residents and frequently do PPS assessments on residents who are admitted and transferred to acute the same day. Judging by Rena's response, I am wasting my time. According to the other writer, I am not. Which is it? This is a big issue for me!   In a message dated 4/14/2004 6:27:35 AM Pacific Daylight Time, [EMAIL PROTECTED] writes: You can bill Medicare and receive payment anytime a resident is admitted and discharged on the same day.  We do it all the time.  If they went to another Medicare participating facility it does not use a day of utilization, but they still pay the facility (it is considered a non-covered day with covered charges).  Billing should put a '40' in form locator 24 on the UB92.  The 40 tells MC the patient transferred to another facility before midnight on the day of admission.  If they go home it is a utilization day and you do not use the 40.  Either way you are paid. >>> [EMAIL PROTECTED] 04/13/04 09:12PM >>> Not quite.  You can bill Medicare Part A for the day of discharge when it is also the day of admission if the beneficiary was discharged to a provider that does not participate in the Medicare program.  If the resident is discharged to a Medicare-participating provider, such as an acute care hospital, the SNF cannot bill for that day.   To admit you were wrong is to declare you are wiser now than before. --Unknown