Thanks
for the reply. I was sure I was right but the hospital and hospice SW
kept insisting and faxing stuff over to support their position and I needed
reassurance I was right. Faye
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED]
Sent: Tuesday, December 23, 2003
11:09 AM
To: [EMAIL PROTECTED]
Subject: Re: Qualifying hospital
stay
To meet the 3-day qualifying stay
requirement, the hospital 3-day stay must be medically necessary by Medicare's
definition. If it does not meet those requirements, then by definition it
cannot be a 3-day qualifying stay for SNF coverage. In other words, if
Medicare Part A doesn't cover the hospital days, then the 3-day hospital
qualifying stay requirement is not met.
This is from the Medicare Benefit Policy Manual, Chapter 8, Section 20.1
- Three-Day Prior Hospitalization
"To be covered, the extended care services must have been for the
treatment of a condition for which the beneficiary was receiving inpatient
hospital services, including services of an emergency hospital, or a condition,
which arose while in the SNF, or for treatment of a condition for which the
beneficiary was previously hospitalized. In addition, the qualifying hospital
stay must have been medically necessary. Medical necessity will generally be
presumed to exist. When the facts, which come to the intermediary in its normal
claims review process indicate that the hospitalization may not have been
medically necessary, it will fully develop the case, checking with the
attending physician and the hospital, as appropriate. The intermediary will
rule the stay unnecessary only when hospitalization for three days represents a
substantial departure from normal medical practice."
Also, since a 3-day qualifying hospital stay is required before the beneficiary
can receive any Part A coverage, the presumption of coverage cannot apply
without a 3-day qualifying hospital stay.
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj:
Qualifying hospital stay
Date: 12/23/03 5:03:34 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Resident admitted to the hospital by hospice r/t wife no longer able to
cope. Resident has met the 3 day requirement however, medicare denied the
hospital stay and none of the care provided meets the criteria for presumed
coverage and resident will not receive any qualifying skilled care here.
I say not qualified for SNF med A coverage. What do you guys think?
