Eli's Rehab Report

Question: Can I count therapy minutes on a “skip day” (when the resident is not in the building at midnight) or the day of discharge? 

Answer: Yes, you can, answered Carol Siem, MSN, RN, GNP-BC, RAC-CT in a recent Q&A for the Quality Improvement Program for Missouri (QIPMO). But you won’t find this answer in the RAI Manual. Instead, it’s in the Medicare Billing Manual, starting on page 47:

“Payment is not made under PPS unless a covered day can be billed. Also, for a non-covered day such as the day of discharge (for which no payment is possible under PPS), separate billing is not allowed for ancillary services. Ancillary charges for such days have already been included in the PPS rates for those day that can be billed … [A]ncillary charges for services furnished on the day of (but before the actual moment of) discharge are included in the SNF’s cost report and reflected in the final cost settlement…”

What this means: Even though the day of discharge itself is not a Medicare-covered day for your SNF, the PPS per diem for all the covered days leading up to the discharge day “is somewhat higher than it otherwise would have been, reflecting the historical cost of these day-of-discharge services,” Siem explained.