Q&A: Meeting inpatient requirements for SNF discharge

Q: Do you have any advice for organizations to ensure they're meeting three-day inpatient stay requirements for discharging patients to skilled nursing facilities (SNF)?

A: As the Office of Inspector General (OIG) continues to look at patient qualification for these stays, consider the following:

1. Case managers typically arrange SNF care for patients. They are the ones who must ensure that the patient qualifies for the Part A SNF benefit, and they must also ensure that the SNF gets the correct information about the inpatient admission date.
2. The OIG recommended requiring a patient notification form to inform patients about the requirements of the three-day rule. While CMS has so far opted not to adopt this recommendation, if they do, case managers will likely be the ones who need to distribute that notification, just as they do with the Important Message from Medicare and MOON forms.
3. Case managers need to understand how billing staff determines the inpatient admission date that goes on the claim. If the billing staff is using the wrong date (say, basing it on nursing notes and not the admission order), that could lead to a SNF denial.

For more information, see Case Management Monthly.