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Uncomplicating the Interrupted Stay Policy

By Jessie McGill, RN, RAC-MT, RAC-MTA - September 24, 2019

SNFs are in the final stage of preparation for Patient-Driven Payment Model (PDPM) implementation, but alongside the payment model’s introduction, new policies are being introduced that add layers of complexity that nurse assessment coordinators (NACs) must master this fall. For example, the new Interrupted Stay Policy adds a whole new critical thinking process to what has been a simplified PPS schedule. However, the Interrupted Stay Policy does not need to cause anxiety—it just needs to be better understood.  Here are seven tips to uncomplicate the Interrupted Stay Policy:

1.       Understand the two criteria of the Interrupted Stay Policy.

The Interrupted Stay Policy essentially combines multiple SNF PPS stays that are separated by less than three days into one stay when the resident meets both of the following criteria:

1.       Resident returns to the same skilled nursing facility (SNF), and

2.       Returns by 11:59 pm of the third calendar day

The Interruption Stay Policy also introduces the concept of the “interruption window,” which begins with the calendar day of discharge and includes the two calendar days immediately following. If the resident’s Medicare stay ends, and the resident remains in the facility with benefit days remaining, then the interruption window begins on the first non-covered day and includes the next two calendar days.