Q&A: Convenience Care

Q. If a patient doesn’t leave within a few hours upon being cleared and ready for discharge, and the reason is the family’s convenience, what options exist for a late discharge?

A. CMS offers specific guidance regarding the appropriate steps in this situation. It’s all a matter of counting days for the Medicare beneficiary. The following is a pertinent excerpt from the Medicare Benefit Policy Manual:

“When a patient chooses to continue to occupy hospital or SNF accommodations beyond the checkout time for personal reasons, the hospital or SNF may charge the beneficiary for the continued stay. Such a stay beyond the checkout time, for the comfort or convenience of the patient, is not covered under the program, and the hospital’s or SNF’s agreement to participate in the program does not preclude charging the patient. However, the hospital must provide the beneficiary with an Advance Beneficiary Notice (ABN) before the noncovered services are provided.

Where the patient’s medical condition is the cause of the stay past the checkout time (e.g., the patient needs further services, is bedridden and awaiting transportation to their home or in the case of a hospital, transfer to a skilled nursing facility, or dies in the SNF or hospital), the stay beyond the discharge hour is covered under the program and the hospital or SNF may not charge the patient.”

This reference also discusses the use of Medicare lifetime reserve days, leave of absence, and death on same day as admission.

For more information, see Discharge Planning Guide: Tools for Compliance, Fourth Edition.

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