“Finally Friday!” Will CMS or Congress Kill Medicare’s 3-Day Qualifying Stay for SNF Coverage?

3-Day Stay for SNF Coverage:
Will It Stand or Not?

Regs Review & Another Quiz from Dr. Pahuja

Plus: Interview with a Physician Advisor
Double Certified as a Medical Auditor

Click the image to take Dr. Pahuja's lastest Quiz on the 3-day Qualifying stay for SNF coverage

Click the image to take Dr. Pahuja’s lastest Quiz on the 3-day Qualifying stay for SNF coverage

In a previous week, we heard from two practicing Physician Advisors who are making a huge, demonstrable difference at their respective hospitals, plus we reviewed a case scenario that perfectly demonstrated the value of having a Physician Advisor and a “rounding” program, aimed at preventing audit problems and subsequent denials. At the end of the show, Dr. Deepak Pahuja went thru his scenario and exam, but we did not have time on the show to review the exact regulations that govern the qualifications for Medicare coverage of a SNF stay.

This week, we reviewed all those qualifications, plus we provided some resources where you can find out more about the various projects being conducted by CMS to test whether the 3-Day stay requirement can/should be dropped, to provide better care for either lower or similar costs.

Also – while at the PAUR Boot Camp in Chicago, I met a Physician Advisor who really got me curious about what he was doing… he had TWO certifications as a Certified Medical Auditor. I wondered, why would he do that… and should other Physician Advisors be doing that?  So I invited him on the show, and you should hear what he has to say!

We covered these topics on the show:

  • The regulatory basis for the 3-day stay to qualify for a Medicare-covered SNF stay
  • The pilot projects being conducted by CMS to test removing the 3-day requirement
  • Interview with Dr. Bernard Bettencourt, Physician Advisor and Certified Medical Auditor
  • Review & Quiz for another case scenario from Dr. Pahuja

This week’s handouts included:

The SNF Rules [SLIDES]
MedPAC June 2010 Report to Congress  – Aligning Incentives in Medicare
Costs for Hospital Stays in the United States, 2010
The SNF Test [SLIDES]

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