OIG: CMS should take steps to ensure compliance with SNF three-day rule

The Centers for Medicare & Medicaid Services should take certain actions to ensure compliance with the three-day rule for skilled nursing facilities, the Department of Health and Human Services’ Office of Inspector General said in a report this week. Medicare will only cover a SNF stay for patients discharged from the hospital to a SNF if the patient spent at least three consecutive days as an inpatient at the hospital. Based on a sample of 99 SNF claims, OIG estimated that CMS improperly paid more than $84 million for SNF services that did not meet the three-day rule during calendar years 2013 through 2015. The report recommends, among other actions, that CMS educate hospitals about the importance of explicitly communicating the correct number of inpatient days to beneficiaries and whether the inpatient days qualify subsequent SNF care for Medicare reimbursement, so that beneficiaries understand their potential financial liability related to SNF care.