The recent recommendation from the Medicare Payment Advisory Commission (MedPAC) that the “three-day stay” rule be relaxed is welcome news for many skilled nursing facilities (SNFs). Not only did the commission recommend that up to two outpatient observation days be counted toward the three-day requirement, it also asked Congress to mandate that hospitals communicate better with patients about their status as an outpatient or inpatient and how it might impact their benefits in a skilled nursing facility. (To be clear, the three-day rule is not to be confused with the two-midnight rule, to which CMS has recently proposed changes.)
In a recent ABILITY survey, SNF billers told us that getting a comprehensive view of a patient’s eligibility was one of their top challenges. If enacted, these new recommendations could help alleviate some of those tough conversations between SNF staff and patients. Under current practices, some patients and their families are caught off guard by the news that Medicare will not cover skilled nursing services if patients have been hospitalized under observation status. As if the period surrounding a hospitalization and transition to a nursing facility weren’t stressful enough, patients and families are then presented with additional financial hurdles, and the SNF biller or admissions manager is stuck being the bearer of very bad news.
But with hospitals doing a better job of talking about this issue with patients, SNF staffers can keep their attention on other pressing tasks. Since staying on top of patient eligibility was only one challenge identified by billers in our survey, it’s clear that any change that helps free up time is welcome.
Want to learn more? Click here to read about the survey results, and follow this blog for updates on other issues affecting SNF revenue cycle workers.