MLN
Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare &
Medicaid Services) |
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Part A Information
MLN Matters Number: MM6030
Related Change Request (CR) #: 6030
Related CR Release Date: May 30, 2008
Effective Date: June 30, 2008
Related CR Transmittal #: R1522CP
Implementation Date: June 30, 2008
Charges to Hold
a Bed during Skilled Nursing Facility (SNF) Absence
Provider Types Affected
Skilled nursing facilities (SNF) submitting claims
to Medicare contractors (fiscal intermediaries (FI), and/or
Part A/B Medicare Administrative Contractors (A/B MAC)) for
SNF services provided to Medicare beneficiaries.
What You Need to Know
This article is based on Change Request (CR) 6030 which describes
the policies relating to bed-hold payments in a SNF by updating
the Medicare Claims Processing Manual (Chapter 1
(General Billing Requirements), Section 30.1 (Charges to Hold
a Bed during SNF Absence)).
Background
Charges to a beneficiary for admission or readmission to a
skilled nursing facility (SNF) are not allowable. However,
when temporarily leaving a SNF, a resident can choose to make
bed-hold payments to the SNF. Under the Social Security Act
(Section1819(c)(1)(B)(iii);(see http://www.ssa.gov/OP_Home/ssact/title18/1819.htm
on the internet) and the Code of Federal Regulations (42 CFR
§483.10(b)(5)-(6), a SNF must inform residents in advance
of their option to make bed-hold payments, as well as the
amount of the facility’s charge
| Note that SNFs, but not hospitals, may bill the beneficiary
for holding a bed during a leave of absence if Medicare
requirements are met. |
Bed-hold payments are readily distinguishable from payments
made prior to initial admission, in that the absent individual
has already been admitted to the facility and has established
residence in a particular living space within it. Similarly,
bed-hold payments are distinguishable from payments for readmission,
in that the latter compensate the facility merely for agreeing
in advance to allow a departing resident to reenter the facility
upon return, while bed-hold payments represent remuneration
for the privilege of actually maintaining the resident’s personal
effects in the particular living space that the resident has
temporarily vacated.
One indicator that post-admission payments do, in fact, represent
permissible bed-hold charges related to maintaining personal
effects in a particular living space (rather than a prohibited
charge for the act of readmission itself) would be that the
charges are calculated on the basis of a per diem bed-hold
payment rate multiplied by however many days the resident
is absent, as opposed to assessing the resident a fixed sum
at the time of departure from the facility.
Under §1819(c)(1)(B)(iii) of the Act and 42 CFR 483.10(b)(5)-(6),
the facility must inform residents in advance of their option
to make bed-hold payments, as well as the amount of the facility’s
charge. For these optional payments, the facility should make
clear that the resident must affirmatively elect to make them
prior to being billed. A facility cannot simply deem a resident
to have opted to make such payments and then automatically
bill for them upon the resident’s departure from the facility.”
See Chapter 30 of the Medicare Claims
Processing Manual for related notification requirements.
That chapter is available at http://www.cms.hhs.gov/manuals/downloads/clm104c30.pdf
on the CMS Web site.
Additional Information
The official instruction, CR 6030, issued to your FI or A/B
MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1522CP.pdf
on the Centers for Medicare & Medicaid Services (CMS)
Web site. The revised section of the Medicare Claims Processing
Manual is attached to CR6030.
If you have any questions, please contact your FI or A/B
MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip
on the CMS Web site.
Disclaimer This article was prepared
as a service to the public and is not intended to grant rights
or impose obligations. This article may contain references
or links to statutes, regulations, or other policy materials.
The information provided is only intended to be a general
summary. It is not intended to take the place of either the
written law or regulations. We encourage readers to review
the specific statutes, regulations and other interpretive
materials for a full and accurate statement of their contents.
| News Flash
– The revised Skilled Nursing Facility (SNF) Spell of
Illness Quick Reference Chart (January 2008), which provides
Medicare claims processing information related to SNF
spells of illness, can be accessed at http://www.cms.hhs.gov/MLNProducts/downloads/SNFSpellIllnesschrt.pdf
on the Centers for Medicare & Medicaid Services Web
site. |
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