Interrupted Stay Policy

120.2 - Interrupted Stay Policy (Rev. 10880, Issued: 08-06-21, Effective: 11-08-21, Implementation: 11-08-21) PDPM includes an interrupted stay policy, which would combine multiple SNF stays into a single stay in cases where the patient’s discharge and readmission occurs within a prescribed window (i.e., interruption window), similar to that which exists currently in many other Medicare inpatient facilities. Specifically, if a patient in a covered Part A SNF stay is discharged from the SNF but returns to the SNF no later than 11:59pm of the third consecutive calendar day after having left Part A coverage, then this would be considered a continuation of the same SNF stay. In such cases, no new patient assessments are required and the variable per diem adjustment is not reset. If the patient returns to the same SNF outside the interruption window, or returns to a different SNF, then this would be considered a new stay. The interruption window begins on the first non-covered day following a Part A-covered SNF stay and ends at 11:59pm on the third consecutive non-covered day. The first non- covered day in this context may be different depending on whether the patient actually leaves the facility or simply leaves Part A coverage. Specifically, if the patient physically leaves the SNF, the first day of the interruption window would be the day of departure itself, whereas if the patient simply discontinues Part A coverage but remains in the SNF, the first day of the interruption window would be the day following the final day of Part A coverage. Specifying the endpoint of the interruption window’s third day as occurring at 11:59 pm rather than at midnight is consistent with the regulations at 42 CFR 411.15(p)(3)(iv), which define a beneficiary’s SNF “resident” status for consolidated billing purposes as ending whenever he or she is formally discharged (or otherwise departs) from the SNF, unless he or she is readmitted (or returns) to that or another SNF “. . . before the following midnight” (emphasis added). See §10.1 of this chapter, and also see §20.1 in the Medicare Benefit Policy Manual, Chapter 3, which specifies that in counting inpatient days, “. . . a day begins at midnight and ends 24 hours later.” However, unlike similar interrupted stay policies under some of the other prospective payment systems, the SNF interrupted stay policy is not used in determining whether bundling would apply to services furnished during the interruption. That determination would instead continue to follow the longstanding set of rules under 42 CFR 411.15(p)(3) regarding SNF “resident” status for consolidated billing purposes (see §§10ff.). The day of discharge (as noted above, this date could be different if the patient leaves the facility or simply leaves Part A coverage) is the FROM date and the last day the patient is not in the SNF at midnight is the THROUGH date. Occurrence span code 74 should be reported for each interruption of more than ONE day. The interrupted stay would be recorded on the claim in the same manner as is done for the IRF PPS, and as further discussed in the examples below. Examples: 1) Patient is admitted to SNF on 11/07/19 and is in a covered Part A stay. Patient is discharged from the SNF and admitted to the hospital on 11/20/19. Patient is readmitted to the same SNF on 11/25/19 and is in a covered Part A stay. The readmission is a new stay because more than 3 days have passed from the date the patient was discharged from the SNF and the date the patient was readmitted to the same SNF. New stay Assessment Schedule: Reset; stay begins with new 5-day assessment. Variable Per Diem (VPD): Reset: stay begins on Day 1 of VPD Schedule. 2) Patient is admitted to SNF on 11/07/19 and in a covered Part A stay. The patient is discharged from Part A on 11/20/19 but remains in the facility. The patient returns to a covered Part A stay on 11/22/19. This is a continuation of a previous stay because the patient returned to a covered Part A stay within 3 days of being discharged from a covered Part A stay. Continuation of previous stay Assessment Schedule: No PPS assessments required, IPA optional VPD: Continues from Day 14 (Day of Part A Discharge). Billing Example: Patient is admitted to SNF on 10/1/2019 and discharged to home on 12/25/2019, with an interrupted stay to an IPPS on 10/20/2019-10/22/2019. This was an admission to an IPPS on 10/20/2019-10/22/2019. 10/1/2019 – 10/31/2019 first interim claim, Claim must be billed with occurrence span code 74 and occurrence span dates 10/20 – 10/21/2019 to represent the interrupted stay, 11/1/2019 – 11/30/2019 second interim claim, 12/1/2019 – 12/25/2019 final interim claim, (Occurrence span code 74 only appears on the claim in which its dates fall within the statement covers period – in this example only on October claim). • Accommodation revenue code 018x is reported during the interrupted stay and is when the beneficiary is not present at the midnight census taking time. • Occurrence span code 74 and date range for the interruption. Days for the interruption shall be reported as non-covered, not to exceed 3 days or it will be considered a new admission. On the SNF Medicare bill, the presence of occurrence span code 74 indicates an interrupted stay has occurred. Report occurrence span code 74 with the FROM and THROUGH dates of the interruption in the stay. The day of discharge from the SNF is the FROM date and the last day the patient is not in the SNF at midnight is the THROUGH date. Report accommodation revenue code 18X (leave of absence) and the quantity of leave days. Occurrence span code 74 should be reported for each interruption of more than 1 day along with the dates of each interruption. Revenue code 018X should reflect the total number of days for all occurrence span code 74 entries. In other words, revenue code 018X should be listed on one line, with all interrupted days included in the units column. No charges should be added to this charge line.