ED Coding and Reimbursement Alert

Question: We saw a patient for 24 hours in the emergency department and two days in observation. She was convinced this qualified her for skilled nursing facility (SNF) admission and complained to us when we would not "write her a referral" for the SNF. What can we say to patients about situations like this in the future?

Codify Subscriber

Answer: The patient appears to be operating on the believe that SNF coverage is applicable to beneficiaries who are inpatients for at least three consecutive days. The patient is correct about Medicare's coverage of SNF admissions, but this patient does not appear to have been an "inpatient" at any point in the hospital stay. Let the patient know that Medicare classifies the emergency department and observation unit as outpatient areas, and unless she was actually admitted to the hospital as an inpatient after the physician wrote an order for that service, and then stayed for three days in a row, she won't qualify for SNF coverage.  

Keep in mind that you should provide Medicare patients with a Medicare Outpatient Observation Notice (MOON). The MOON is a standardized notice to inform beneficiaries (including Medicare Health Plan enrollees) that they are an outpatient receiving observation services, and are not an inpatient of the hospital or critical access hospital (CAH). All hospitals and Critical CAHs have been required to provide the MOON since March 2017.

If the patient qualifies for home health care, physical therapy, or other benefits that might help her upon her release from the observation unit, you can advise her of those benefits.