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 Amid OIG Report Release, CMS Unveils New Fact Sheet on 3-Day Rule Billing

A section of the recently released Office of Inspector General (OIG) report on suggested changes to Department of Health and Human Services programs, among other items, said of 25 “significant” unimplemented recommendations is one that calls for the Centers for Medicare & Medicaid Services (CMS) to analyze the potential impact of counting time spent as an outpatient toward the 3-night requirement for skilled nursing facility (SNF) services.

In relation to this issue, CMS has also issued a new fact sheet on the SNF 3-Day Rule Billing process. Long term and post-acute care advocates say this information from CMS is really about keeping providers informed on how the observation stays billing issue is currently intended to work.

In the OIG report, the agency said CMS should analyze the potential impacts of counting time spent as an outpatient toward the 3-night requirement for SNF services so that beneficiaries receiving similar hospital care have similar access to these services.

CMS should also require hospitals to provide a written notification to beneficiaries whose discharge plans include post-hospital SNF care, “clearly stating how many inpatient days of care the hospital provided and whether the 3-day rule for Medicare coverage of SNF stays has been met,” the OIG report said.

Industry advocates at the American Health Care Association/National Center for Assisted Living said SNFs support efforts and legislation that ensure that time spent under “observation status” in a hospital counts toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing care services under Medicare.

“The observation stays issue is an outdated policy that continues to leave millions of Medicare beneficiaries surprised by thousands of dollars in medical bills and hanging with uncertainty regarding their access to the Medicare coverage they deserve,” AHCA/NCAL said.

In the new fact sheet, CMS tells providers that improper Medicare payments may occur when a hospital discharges an inpatient Medicare beneficiary before the patient meets the 3-day rule and the SNF admits the patient for extended care services. The fact sheet also explains how to understand coverage rules and the Medicare SNF claims processing system.

See for the fact sheet.​​

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