Determine Utilization on Day of Discharge, Death, or Day

40.3.5 - Determine Utilization on Day of Discharge, Death, or Day Beginning a Leave of Absence (Rev. 4001, Issued: 03-16-18, Effective: 06-19-18, Implementation: 06-19-18) 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 another, nonparticipating provider (or to a nonparticipating portion of the same provider) before the following midnight. 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, for a noncovered day such as the day of discharge (for which no payment is possible under PPS), separate billing is not allowed for ancillary services. Ancillary charges for such days have already been included in the PPS rates for those days that can be billed. This is because, in accordance with the longstanding instructions in Pub. 15-1, Provider Reimbursement Manual, Part I, chapter 22, section 2205.1, ancillary charges for services furnished on the day of (but before the actual moment of) discharge are included on the SNF’s cost report and reflected in final cost settlement (see also §40.6.3). Accordingly, such charges have been built into the PPS base. As a result, even though the day of discharge itself is not a Medicare-covered day for the SNF, the PPS per diem for all of the covered days leading up to the day of discharge is somewhat higher than it otherwise would have been, reflecting the historical cost of these day-of-discharge services. When a patient is discharged on the first day of a provider’s participation or the first day of the patient’s entitlement, complete the bill as follows: • Admission date is the actual date of admission; • From date of service is the date the patient became entitled or date the SNF began participation; and • The number of noncovered days = 1.