The thing about interrupted stay is that they are quite uncommon and as a result, they tend to escape the daily attention of people. Simultaneously, they are also quite tedious to fix and have the potential to disrupt a complete Medicare cycle. Interrupted stay provisions allow patients to leave the facility for a stipulated amount of time. Upon returning, the care continues without any breaks.
Therefore, if the detail recording has some gaps, then the claim can be rejected. This is why professional SNF billing prioritizes interconnecting these interrupted stay claims seamlessly. Because this connection point is one of the major areas where such claims primarily break.
What Counts as an Interrupted Stay?
Understanding the fundamentals of interrupted stay is an important detail to begin with. As per the regulations set forth by Medicare for interrupted stay, a resident who is discharged from Part-A covered care must return to the same facility for same Part-A service within a stipulated time. As per regulation, the stipulated time is two business days.
If these steps are followed, then the Medicare treats such episodes as part of one continuous stay for the PDPM purposes. In fact, in such cases, the return is not treated as a new admission. In fact, it is seen as part of a continuous stay. Therefore, it does away with the preliminary 5-day assessment cycle as SNFs generally do for new admission.
Interrupted stay rule must not be confused with the Medicare's qualifying inpatient hospital stay requirement. If a biller confuses these two, then the billing operation can end up committing grave mistakes in calculating the bill. As a result, leading to a financial breakage can lead to hampered operation.
When the Return Becomes a New Stay
What happens when the aforementioned rules are not followed? In this case, the return might be treated as a new admission. In this case, the return is seen as a new admission where the patient will be billed according to the standard norms that skilled nursing facility billing teams need to follow.
This is very important for a biller to keep in mind. Therefore, if a biller is facing a patient file who is returning, they need to assess every little detail. These include the service line history, along with the medical necessity note, and the discharge note from the previous stay. Otherwise, leading to a billing gap.
Why Interrupted-Stay Errors Develop
An interrupted stay error does not begin when the final form is being prepared. They usually begin much earlier in the pipeline due to missed departmental notes, incorrect recording of time, etc. Here are some of the most common reasons that can lead to an interrupted stay error.
Census and Clinical Systems Do Not Match
Modern skilled nursing facility billing services generally use integrated software in order to generate billing events and assess schedules from the census entry itself. As a result, if the front office is personnel fails to record details effectively, then the wrong even type is selected by the system. Hence, leading to a creation of a new stay bill.
Hence, the front office must have a proper plan of action when it comes to detail recording. Here is what a dependable SNF billing workflow must compare before billing:
- The last covered Part A date
- The resident’s physical departure date
- The first noncovered date
- The date and time on which covered care resumed
This comparison is more reliable and relevant than simply relying on admission notes alone. Assessing these said data points can truly help providers to have a clearer look at whether a stay qualifies for an interrupted stay or not.
MDS Decisions Are Made Too Early
Another major problem area for such stays that SNF billing face is early recording of MDS decisions. If this is done too early, then the billing and the MDS team might reach a different conclusion when it comes to the resident's status. While one team will create a claim that factors in interrupted stay parameters, the other can bill the services as part of newer stay. As a result, creating an area of professional disagreement is important.
This problem becomes more complicated to fix when the resident simply leaves within the first eight days. This can create an informational gap which can become a major problem area to handle. Any incorrect assumption by SNF billing outsourcing services in order to fill this gap can backfire.
Physician Certification Dates Are Overlooked
For interrupted stay claims that qualify, the physician's certification as well as recertificating schedules must follow a standard calendar day format. The process simply does not pause when the resident is away. In fact, if the patient is readmitted with newer problems, then the readmission can be treated as a new stay.
This is why SNF billing solutions take specialized care when it comes to qualifying stays. They must ensure every detail aligns and fall within the narrow regulatory landscape of these claims. Otherwise, creating unnecessary rework and procedural loss.
Use Technology Without Removing Human Cognizance of SNF Billing Teams
Yes, technology has the power to revamp billing in the right manner. It can connect different processes seamlessly and can cut down on processing time. But a software cannot solve or anticipate every issue that an SNF billing team can face.
So, what it needs is human cognizance. The right skilled nursing facility billing architecture must be a combination of technology and human judgement. Where tech is used to expedite the [processing power, but human cognizance is used for decision making.
This not only helps billers to churn out cleaner interrupted stay claims but also helps them to do it at a much quicker pace. As a result, preparing the skilled nursing facility for future-plans of scaling, without adding more resources.
Preventing the Error Is Less Costly Than Rebuilding the Stay
Interrupted stays are rarer than a hen's teeth, but that does not mean that a billing department must not know how to deal with it. The right way to handle this and every other billing challenge is to let the professionals take over.
Which means that a skilled nursing facility should bring in expert and professional SNF billing services. These specialized billers not only help providers to deal with billing effectively but also keep them compliant. Therefore, the one true way to deal with errors is to let the professionals take over.
