- Outpatient Services for Registered Inpatients
- Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Annual Wellness Visits ‑ Billing Tips for Physicians
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Billing Medicare Part A When VA-Eligible Medicare Beneficiaries Receive Services in Non VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Electronically Submitted Claims that Exceed $99,999.99
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
- Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims
What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
Table of Contents
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Three-Day or Less Interruption from a LTCH
- LTCH Three-Day or Less Interrupted Stay Policy
- Facility/Facilities That Render Services to Patients During Three-Day or Less LTCH Interruptions
- Related Content
What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
To bill properly and ensure you receive payment from the appropriate entity for services you rendered to Medicare patients who were inpatients in a LTCH before and after the services you rendered, all facilities (ACHs, SNFs, IPFs, IRFs, etc.) must follow the LTCH three-day or less interrupted stay policy. Part of this policy requires you to bill the LTCH and not Medicare. Please review the information below and share it with your billing staff.
Three-Day or Less Interruption from a LTCH
A patient incurs a three-day or less interruption from a LTCH inpatient stay if he/she was
- an inpatient in an LTCH,
- discharged or transferred (or left) the LTCH, and
- readmitted (or returned) to the same LTCH within three days.
To count the days of the interruption, count:
- day one as the day the patient was discharged or transferred from (or left) the LTCH and
- days two and three as the calendar days that follow day one.
The patient’s readmission (or return) to the same LTCH must occur by midnight of day three.
Examples of interruptions from a LTCH:
- One-day = Patient leaves a LTCH on Monday and returns to same LTCH by midnight the same day
- Two-day = Patient leaves a LTCH on Monday and returns to same LTCH by midnight on Tuesday
- Three-day = Patient leaves a LTCH on Monday and returns to same LTCH by midnight on Wednesday
LTCH Three-Day or Less Interrupted Stay Policy
If a patient incurs a three-day or less interruption from a LTCH stay, the LTCH combines the patient’s inpatient LTCH stays into one claim for Medicare.
The LTCH never codes one-day interruptions on that one claim. This is true whether the patient received services at another facility or not during such interruptions. Medicare makes one payment to the LTCH including the interrupted day.
The LTCH may or may not code two-day and/or three-day interruptions on that one claim. This depends on whether the patient received services at another facility or not during such interruptions. The LTCH:
- codes two-day and/or three-day interruptions on that one claim if the patient did not receive services at another facility (or facilities) during such interruptions. The LTCH receives one Medicare payment less the interrupted days.
- does not code two-day and/or three-day interruptions on that one claim if the patient did receive services at another facility (or facilities) during such interruptions. The LTCH receives one Medicare payment including the interrupted days.
Facility/Facilities That Render Services to Patients During Three-Day or Less LTCH Interruptions
When a patient receives services at another facility (or facilities) during a three-day or less interruption from a LTCH stay, those services are the LTCH’s responsibility. To pay facilities who rendered services to patients on a three-day or less interruption from a LTCH stay, the LTCH follows CMS’ “under arrangements” policy in Section 10.4 titled “Payment of Nonphysician Services for Inpatients” of the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 3.
LTCHs try to make other facilities aware of the three-day or less interrupted stay policy. However, is not always possible. So, you may learn of the situation some other way or from some other source. You may even learn of the situation after submitting a claim to us and receiving a claim rejection because the LTCH previously submitted their claim to us.
If your facility rendered services to a patient and is aware that the services occurred during a three-day or less LTCH interruption, bill the LTCH and not Medicare. If your facility rendered services to a patient and is not aware that the services occurred during a three-day or less LTCH interruption, bill Medicare. However, when you do become aware of the situation, you must cancel your Medicare claim and bill the LTCH.
If the LTCH advises us that your facility is aware of the situation, but you will not cancel your Medicare claim, then we may request medical records from all facilities involved and cancel the necessary claim(s) so that all facilities involved can bill properly.