PDPM: Interrupted Stay Policy
We’ve been busy working with our skilled nursing facility partners to prepare for the Patient Driven Payment Model (PDPM), a new case-mix classification system for classifying skilled nursing facility (SNF) patients that begins October 1, 2019. Not sure what information to provide your SNF office staff about the upcoming changes? Share this information on the new Interrupted Stay Policy from RehabVisions’ Regulatory and Reimbursement Specialist to help prepare your facility for a successful transition to PDPM:
Interrupted Stay Policy: The Interrupted Stay Policy is being introduced by CMS in conjunction with the Patient Driven Payment Model. This new policy sets out criteria for determining when Medicare will treat multiple SNF stays occurring in a single Part A benefit period as a single “interrupted” stay, rather than separate stays, for the purposes of the assessment schedule and the variable per diem payment schedule.
When the stay is considered “interrupted” under the Interrupted Stay Policy, both the assessment schedule and the variable per diem payment schedule continue from the point just prior to discharge. When the stay is not considered interrupted, both the assessment schedule and the variable per diem rate reset to Day 1, as it would in a new stay.
An “interrupted” stay is one in which a patient is discharged from Part A SNF care and subsequently readmitted under the following TWO conditions:
- The patient returns to Part A care in the same SNF (not a different SNF); AND:
- The patient returns within three days or less (the “interruption window”)
If both conditions are met, the subsequent stay is considered a continuation of the previous “interrupted” stay. This would mean that the variable per diem schedule continues from the day of the previous discharge. For example, if a patient was discharged on Day 7, payment rates resume at Day 7 upon readmission. The assessment schedule continues from the day of the previous discharge. No new 5-day assessment is required. However, an optional IPA may be completed at clinician’s discretion.
If the patient is readmitted to the same SNF more than three consecutive calendar days after discharge, OR in any instance when the patient is admitted to a different SNF (regardless of time between stays), then the Interrupted Stay Policy does not apply and the subsequent stay is considered a new stay. This would mean that a new 5-day assessment is required and that the variable per diem schedule resets to Day 1.
PDPM is the first significant change to the SNF reimbursement model in 20 years. Our skilled nursing facility division is staying up-to-date on all things PDPM-related, helping our partners prepare for PDPM. Let’s countdown to PDPM together.
For additional details on the Patient Driven Payment Model, please visit the CMS PDPM Page