Are you facing this dilemma at your facility? You need to know when a patient at your facility qualifies to be in a skilled nursing facility (SNF). But, first, how impaired do they have to be? What kind of conditions need to be present? Does the Part A SNF stay have to be an exact continuation of the hospital services? Do the exact same conditions have to be treated? What if something new happens? What if the discharge supports changes?
Today, more than ever— especially with the advent of Medicare Advantage and commercial auditors— you and your team need to have a comprehensive understanding of the relationship between a stay in the acute care hospital and a stay in a SNF. Knowing the difference can be challenging. Being caught between what you think the patient needs and what you think the guidelines say is a painful place to be. And you end up afraid of an unsafe discharge on the one hand or, on the other hand, a denied episode of care by an auditor.
Being fluent in translating the care continuum between a hospital and a SNF makes a huge difference. When the utilization specialists and case managers at the acute care facility know what does and doesn't support a Part A stay in the SNF, there's less anxiety about feeling like the only option is home for patients who show medical risk but are higher functioning or need a shorter stay. When the SNF interdisciplinary team (IDT) knows what conditions need to be present to maintain a Part A benefit they're less likely to decline an admission or feel like they need to end a stay prematurely.
Thanks to this exclusive RACmonitor webcast, you'll know how to get the patient to the right place for the right amount of time. Attend this webcast and gain the knowledge of how the clinical needs are supported by rules from the Centers for Medicare & Medicaid Services.
Why This is Relevant:
The demand for better outcomes and fewer readmissions creates tension for the people in charge of what patient goes where and for how long. You want the patient to be in a clinically appropriate environment to manage their risk, but worry about the risk for an unpaid claim if the setting doesn't appear to be medically supported. You need to know the crosswalk that links the acute care and the SNF episode, so you can be confident knowing that the patient is going to the right place for the right length of time to support their medical and functional recovery.
During this exclusive RACmonitor webcast, you and your team will…
- Understand how the "daily skilled service" requirement is met at a SNF.
- Know how the medical and functional presentations inter-relate when considering a SNF episode.
- Learn how the oversight of a new medical condition and the development of nursing treatment plan supports a SNF admission.
- Understand how to meet the CMS Part A requirement to deliver services for a "condition that received treatment in the hospital" and what factors influence eligibility.
- Come to appreciate how the demands of the home environment support a transfer to a skilled nursing facility after an acute event.
Who Should Attend:
Case managers, inpatient coding and HIM professionals, hospital compliance and audit and appeal managers and directors, RAC coordinators, case managers, utilization specialist, SNF admission coordinators, and SNF interdisciplinary members.