You sent a discharge claim prior to readmission, now what?

Mar 01, 2019
The Bottom Line

Readmission occurs when the beneficiary is discharged and then readmitted to the SNF, needing skilled care, within 30 days after the day of discharge. Such a beneficiary can then resume using any available SNF benefit days, without the need for another qualifying hospital stay. The same is true if the beneficiary remains in the SNF for custodial care after a covered stay and then develops a new need for skilled care within 30 consecutive days after the first day of noncoverage.

If you sent a discharge claim prior to readmission, submit another bill and report:

  • The current stay admission date

  • Condition code 57

  • Occurrence span code 70 with the qualifying hospital stay dates

If the beneficiary is readmitted before you send a discharge claim, submit an interim bill and report:

  • The current stay admission date

  • Condition code 57

  • Occurrence span code 70 with the qualifying hospital stay dates

  • Occurrence span code 74 showing the LOA “From” and “Through” dates and the number of noncovered days

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SNFSpellIllnesschrt.pdf

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