Content Section
Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).
|
Issue 2006-05, May 2006
Three-Day Qualifying Hospital Stay for Skilled Nursing Facility (SNF) Admissions
Occurrence Span Code 70 - The from/through date of at least a three-day hospital stay that qualifies the patient for Medicare payment of SNF services billed. |
Providers have an obligation to verify qualifying hospital stays and are advised to check their admissions and readmissions carefully for valid hospital stay information. The dates associated with Occurrence Span Code 70 must match the dates billed by the hospital.
The three-day qualifying hospital stay begins with the day the beneficiary is actually admitted to the hospital as a Part A inpatient. Sometimes what appears to be the required three-day qualifying hospital stay is really something less due to time spent in other areas of the hospital. Many beneficiaries are held in treatment and/or observation rooms prior to admission. Emergency and observation room extended stays do not count as a hospital day in calculating a qualifying stay unless the beneficiary was admitted as an inpatient to the hospital on the same day as entering an ER or observation room.
Occurrence Span Code 70 Requirements:
- The beneficiary must have been an inpatient of a hospital, receiving medically necessary hospital care, for at least three consecutive calendar days. Note: The discharge day is not to be counted as part of a three-day qualifying hospital stay. Also, the days should be reimbursed by Medicare as covered days.
- The transfer to a participating skilled nursing facility or to the swing-bed must have been within 30 days after discharge from the hospital.
- The date of discharge from the prior-stay hospital must have occurred on or after the first day of the month in which the beneficiary became eligible for Medicare.
SNF claims received that do not follow the above requirements will be rejected.
Please refer any further questions to our Provider Inquiries Call Center at 888-855-4356.
|
