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

Get ready for October 1

Transportation – New Item A1250

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See An additional item we will see in the upcoming MDS 3.0 v.1.18.11 in October 2023 is A1250 - Transportation. This is included in a new subset of...

New 3-day Lookbacks | Assessment Periods

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of March 24, 2023 What You Can Expect to See New 3-day lookback/assessment periods are coming to the MDS world. There are different sections of the MDS that the Nurse Assessment Coordinators...

New Pain Interview in Section J

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 22, 2023 What You Can Expect to See The most noticeable changes to Section J are evident in the pain interview, specifically questions J0510, J0520 and J0530. The RAI Manual has...

Section B – Hearing, Speech and Vision Changes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See Section B on the MDS is a component of the Standardized Patient Assessment Data Elements (SPADEs), which is utilized across post-acute care...

Race and Ethnicity – Changes in Section A

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See Section A, Identification Information for Race/Ethnicity has expanded. One of the major changes is the deletion of section A1000 Race/Ethnicity....

Read more on Toolbox Essentials

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...

COVID-19 Resources

COVID-19 (coronavirus) Tools In this difficult time, MDS Consultants is here for you with reimbursement guidance and can help with MDS completions when needed. Our team keeps an up-to-date list of links and resources at MDS Expert  COVID-19 (coronavirus) Updates Novel...

MORE from MDS Experts

Coding UTIs on the MDS 3.0

Urinary Tract Infections (UTIs) are a commonly miscoded data element on the MDS. Are you over coding UTIs? Are you not coding them at all? Should you? Shouldn’t you? The MDS has historically left data collectors asking themselves these questions. What happens if I do...

Achieving Accurate ADLs with the OSA

Section G of the MDS 3.0 was retired October 1, 2023, yet the MDS nurse may still need to use the knowledge of accurately coding ADLs with an assessment called the Optional State Assessment (OSA).  State-Optioned OSA Although the option to choose an OSA from the...

What Is an MDS Coordinator?

It’s a bit odd that when asked what you do for a living most MDS coordinators struggle to come up with an answer. Who struggles to explain what they do every day? The reality is that MDS Coordinators fully understand what this multifaceted job entails, but are at a...

MDS 2023 Countdown Wrap-Up

This post is part of the MDS 2023 Countdown series.  Disclaimer: Current as of May 13, 2023.   What You Can Expect to See CMS released the first MDS draft item set (v1.18.11) in September 2022, which generated many questions for the long-term care community. Both...

Rx Reconciliation – New SNF QRP and QMs

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See The reconciled medication list will have a new documentation requirement that will go into effect with the October 1, 2023 changes to the MDS...

Webinars & Training

Grow your knowledge with our MDS education

MDS Guides & Forms

Exclusive resources & tools we use every day

Ask an Expert Forum

Members can get 1:1 advice from our MDS experts

Let's Meet in Person

Get more info on our training & conference schedule

News for MDS Experts

Browse our blog & get news alerts on MDS changes

MDS Completion

Get your MDS' done ASAP with short-term, expert help

Remote Floater

Fill gaps on your team when & where you need

Case Mix Index

Improve your complex case mix calculations

MDS System Mgt

Best practices for MDS schedules & workflow

+ More Services

Get help on PDPM, ICD-10, quality, schizoph. audits ++