Q&A: Working with families who request a SNF transfer

Q. What do we do when families want their loved one admitted as a hospital inpatient so he or she can qualify for a transfer to a skilled nursing facility (SNF)?

A. If the patient has a condition that warrants hospital care that is expected to require two or more midnights, the patient should be admitted as inpatient. If that inpatient stay lasts more than three days, the patient can be evaluated for transfer to a SNF under Part A.

If the patient does not require an inpatient level of hospital care, he or she should not be admitted to the hospital as an inpatient solely to accumulate the three inpatient days needed for a qualifying covered SNF stay. The patient is unlikely to have a condition that requires skilled care on a daily basis if he or she does not require an inpatient stay. It is more likely that the patient requires custodial care that the family is no longer able to provide, and custodial care is not a covered Medicare benefit.

When a patient or family insists on inpatient admission, the physician has the option of admitting the patient and then notifying the care management staff who will issue a Preadmission Hospital-Issued Notice of Non-Coverage (HINN). This form will notify the patient and family that the hospital feels the admission is for non-medical reasons (a social admission) and therefore the hospital will be billing the patient—not Medicare—for the hospital stay. Furthermore, an admission accompanied by a Preadmission HINN will not be considered a qualifying stay for SNF coverage.

The family will have the option of taking the patient home, agreeing to transfer to a long-term care facility and pay out of pocket, or allowing the patient to be admitted and accepting financial responsibility (without accruing the needed days for SNF qualification.) The hospital will assist the family in arranging transfer to a long-term care facility for the needed custodial care or arranging needed home assistance.

Editor’s note: This question was answered by Ronald Hirsch, MD, FACP, CHCQM, of R1 Physician Advisory Services in Chicago.

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