Tuesday, August 6, 2019

Amid OIG Report Release, CMS Unveils New Fact Sheet on 3-Day Rule Billing

Dana Halvorson

A section of the recently released Office of Inspector General (OIG) report on suggested changes to Department of Health and Human Services programs, among other items, said of 25 “significant” unimplemented recommendations is one that calls for the Centers for Medicare & Medicaid Services (CMS) to analyze the potential impact of counting time spent as an outpatient toward the 3-night requirement for skilled nursing facility (SNF) services so that beneficiaries receiving similar hospital care have similar access to these services.  In relation to this issue, CMS has also issued a new fact sheet on the SNF 3-Day Rule Billing process and how it is currently intended to work.
AHCA/NCAL supports efforts and legislation that ensures that time spent under “observation status” in a hospital counts toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing care services under Medicare.  The observation stays issue is an outdated policy that continues to leave countless Medicare beneficiaries surprised by thousands of dollars in medical bills and hanging with uncertainty regarding their access to the Medicare coverage they deserve.  For more information about the observation stays issue, please visit the AHCA/NCAL website.         

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