CMS Issues Revised MLN Matters on Qualifying Three-Day Stays

by Ronald Hirsch, MD, FACP, CHCQM

An inadvertent change in CMS guidance from “subsection (d) hospital” to “acute care hospital” to “IPPS hospital” resulted in eligible patients being denied admission to long-term care hospitals (LTCH). You may recall reading about this in the article “What a Difference a Word Makes: Qualifying Three-Day Stays,” published October 4. In response to the article and the author’s contact with CMS, a revised MLN Matters SE1627 was published October 18.

In its revision, CMS clarified that if there is no eligible admission with an eligible intensive care unit stay within the claims processing system and the claim was therefore paid at the site-neutral rate, the LTCH should contact the Medicare Administrative Contractor who will verify the admission at a subsection (d) hospital and make the payment adjustment from site neutral to LTCH rates.

While CMS has a budget that approaches $1 trillion and over 6,000 employees, it is heartening to see that they still pay attention and listen to the individual.

Editor’s note: Hirsch is the vice president of the Regulations and Education Group at Accretive Health in Chicago.