Can I interrupt? Understanding the Interrupted Stay Policy

by | Jul 22, 2021 | CAA & Care Plans, Tool Box Essentials

Explore More Posts from MDS Consultants

According to the RAI Manual, chapter 6:

“The interruption window is a 3-day period, starting with the calendar day of Part A discharge and including the two immediately following calendar days, ending at midnight. In other words, the resident must return to the same SNF by 11:59 p.m. at the end of the third calendar day. The interruption window begins on the first non-covered day following a Part A-covered stay and ends at 11:59 p.m. on the third consecutive non-covered day following a Part A-covered stay.”

If, for example, the resident left the facility on June 4th and returned on June 7th. This scenario is not an interrupted stay. The facility would need to complete a new 5-day assessment. The resident was gone for “3-midnights” on the 4th, 5th, 6th.

However, If the resident left on June 4th and returned on June 6th, this scenario Is an interrupted stay. The facility would not do another 5-day assessment.

Remember, the Interrupted stay policy applies anytime the Medicare part A stay ends, and the resident returns to skilled status in the same facility before the 3rd midnight. Residents that drop to a non-skilled level of care and stay in the facility are included in the Interrupted Stay Policy. The policy would also include discharged home residents or even leave Against Medical Advice (AMA).

When a resident returns from an interrupted stay, the facility should “just pick up where you left off.” Take the example above, the resident left on June 4th and returned on June 6th. Let’s assume that June 4th would have been the resident’s 22nd day of their stay. When the resident returns, the 6th now becomes the 22nd day of the stay. The facility does not need to complete a new 5-day assessment.

Summary

The Variable Per Diem Adjustment would remain as indicated for day 22 of the stay. The Physicians Certification will also be continued. In other words, the Medicare part A stay did not end; it was just “interrupted” for a couple of days.

Ensure that the interdisciplinary team knows when and how to utilize the Interrupted Stay Policy. If this policy is not applied appropriately, it may lead to an overpayment due to the variable per diem adjustments under PDPM.

Interrupted stays are a topic that is sure to be targeted by Medicare Administrative Contractors when auditing. The facility will want to correctly assign an interrupted stay according to policy to avoid additional audits and to the appearance of fraud or abuse.

Explore More Posts from MDS Consultants

Reimbursement Concerns

Maximizing Case Mix with Special Programs: Respiratory Therapy and Restorative Nursing

Case mix is essential in skilled nursing facilities as it impacts both reimbursement and the care provided. Two key programs that significantly impact case mix scores when properly implemented and documented are Respiratory Therapy and Restorative Nursing. Both...

Strategic Admissions: The Path to Optimized Medicaid Reimbursement

Medicaid reimbursement plays a significant role in the financial health of long-term care facilities, particularly those serving a high percentage of Medicaid residents. While it may not be the sole source of revenue, it is an important component that supports the...

Interim Payment Assessment (IPA) – To do or not to do?

The Patient-Driven Payment Model took effect in October of 2019. Along with this change came the optional IPA. We are now five years into this change and questions still arise on when to complete an IPA. The decision of when to complete lies with the team at the...

Resident Interviews – What are you doing to capture the data?

Effective October 1, 2023, several resident interviews were added to or updated on the MDS. Interview items in Section A and changes to the interviews in Section D, J, and Q have been implemented. Each of the interviews can be a great steppingstone in your path to...

Social Determinants of Health (SDOH) – A Global Initiative Important to Skilled Nursing Providers

The Centers for Medicare & Medicaid Services’ (CMS) Office of Mental Health report CMS Framework for Health Equity 2022 and 2032 states that health equity is defined by the attainment of the highest level of health for all people, where everyone has a fair and...

Read more on Toolbox Essentials

Focused Infection Control Surveys and Directed Plan of Correction

It's a dreary Monday morning, and the state surveyors walk into your facility to conduct a Focused Infection Control survey. You and your team have been trying your hardest to comply with infection control procedures throughout the pandemic. At the end of the survey,...

New Advanced Beneficiary Notice

Is your facility using the proper ABN form? The Centers for Medicare & Medicaid Services (CMS) recently updated the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The new ABN will be mandatory for use on 1/1/2021, but the new form can be...

Covid-19 and Skilled Status

In late June, CMS addressed two issues and posted MDS 3.0 Final Item Sets (V1.17.2).  The two edits were changes to facilitate the calculation of Patient-Driven Payment Model payment codes on OBRA assessments for states that wish to have this calculation performed. ...

Mind Your PHQs

Some skilled nursing facilities (SNFs) are concerned about accurate payment when a resident unexpectedly discharges and the Brief Interview for Mental Status (BIMS) has not yet been completed.However, they should be just as concerned about the PHQ-9. The PHQ-9...

MDS in the Emergency Preparedness Plan

The COVID-19 pandemic has highlighted the need for skilled nursing facilities to have an effective Emergency Preparedness Plan - one that includes sheltering-in-place. The Centers for Medicare and Medicaid Final Rule requires that participating providers have an...

MORE from MDS Experts

A Significant Change in Status Assessment – There are Options

The Resident Assessment Instrument (RAI) system includes a significant change in status assessment (SCSA). What might be forgotten is the State Operation Manual (SOM), Appendix PP, includes information that mirrors the RAI manual at 42 CFR §483.20(b)(2)(ii), F637 -...

Interim Payment Assessment (IPA) – To do or not to do?

The Patient-Driven Payment Model took effect in October of 2019. Along with this change came the optional IPA. We are now five years into this change and questions still arise on when to complete an IPA. The decision of when to complete lies with the team at the...

Resident Interviews – What are you doing to capture the data?

Effective October 1, 2023, several resident interviews were added to or updated on the MDS. Interview items in Section A and changes to the interviews in Section D, J, and Q have been implemented. Each of the interviews can be a great steppingstone in your path to...

Section GG Documentation – Questions Still Abound

Section GG remains a popular discussion topic among the Nurse Assessment Coordinator (NAC) and other members of the interdisciplinary team (IDT). Many have questioned their own practices and processes, designed to support coding this section of the MDS. CMS states in...

Social Determinants of Health (SDOH) – A Global Initiative Important to Skilled Nursing Providers

The Centers for Medicare & Medicaid Services’ (CMS) Office of Mental Health report CMS Framework for Health Equity 2022 and 2032 states that health equity is defined by the attainment of the highest level of health for all people, where everyone has a fair and...