Would a new initial certification be due “at the time of admission, or as soon thereafter as is reasonable and practicable”?Īnswer: Yes, a new initial certification would be needed, say officials. Medicare payment and the variable per-diem adjustment schedule would restart at day 1. Question: If this same resident left the facility on day 38 and returned to a Part A skilled level of care in the same SNF on day 42, the resident would be admitted as a new admission with a new PPS 5-day required, according to the interrupted stay policy. Is the second recertification, which must be completed no later than 30 days after the first recertification, due by the new day 39 of the updated Medicare schedule, i.e., the day after the resident’s return? Are the noncovered days skipped over for the recertification just like they are for payment and the variable per-diem adjustment schedule?Īnswer : “The recertification would be due no later than day 39 of the revised Medicare schedule, which would be when the patient returns from the interrupted stay,” state CMS officials. Question: This resident’s second recertification was due on day 39 of the original Medicare schedule but was missed because they were out of the facility. Payment, covered by the existing PPS 5-day unless the facility chooses to complete an Interim Payment Assessment (IPA), resumes on the new day 38 upon readmission/return because it is a continuation of the previous stay, and the variable per-diem adjustment schedule resumes on the new day 38 as well. That day 40 from the initial Medicare payment schedule resets to day 38 (the first noncovered day, which in this scenario is the day of discharge) on the updated Medicare schedule because those noncovered days are skipped over. They return to the same SNF to receive a Part A skilled level of care on day 40, meeting the requirements for an interrupted stay. The resident leaves the SNF and is admitted to the acute-care hospital on day 38. If a beneficiary is discharged from the SNF (or from the covered Part A stay) and then resumes covered SNF care within the interruption window, the subsequent resumption would not be considered a new admission and, thus, would not trigger a new certification/recertification schedule.Ī resident in a Part A SNF stay receives their first physician recertification on day 9 of their stay. The existing requirements governing level-of-care certification and recertification timeframes are tied to a beneficiary’s SNF admission. Here is the FAQ excerpted from Patient-Driven Payment Model: Frequently Asked Questions (FAQs):ġ3.21: How Does the Interrupted Stay Policy Affect Medicare Physician Certification? “This also tracks with previous statements we have made comparing the recertification timeline with the variable per-diem schedule, and interrupted stays have similar impacts on both, as noted in response to FAQ 13.21,” say officials. Note: Review the physician cert/recert section of the Code of Federal Regulations in the box at the end of this article. “The regulations at 42 CFR 424.20(d) state that the first recertification is required no later than ‘the 14 th day of post-hospital SNF care.’ This would have the schedule track with the days of the stay (i.e., covered days) rather than calendar days,” explain officials. This adjustment brought to light the fact that some SNFs may be counting calendar days instead of Medicare days to determine when certs/recerts are due-a practice that is incorrect CMS officials tell the American Association of Nurse Assessment Coordination (AANAC). when they should continue using the existing cert/recert to account for the interrupted stay policy that was implemented in conjunction with PDPM. However, the Centers for Medicare & Medicaid Services (CMS) did adjust the instructions in the Medicare Online Manual System to explain when providers need to obtain a new physician certification vs. The physician cert/recert policy did not change with the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019. To bill under traditional fee-for-service Medicare Part A, skilled nursing facilities (SNFs) must obtain appropriate, timely physician certifications and recertifications of posthospital inpatient extended-care services.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |