Medicare Part A Short Stay Assessments
Knowing the Rules Can Increase Reimbursements
The Medicare Part A Short Stay Assessment (“SSA”) rules allow some flexibility in RUG’s level selection for patients that are discharged on Day 8 or earlier. An early discharge often results from circumstances beyond your control. In some instances, the conditions can be “managed” to achieve the highest RUG’s level that is medically appropriate. This might occur if the patient arrives at the facility with only 8 days or less of covered benefits. Proper planning of treatments, ARD selection, and the discharge date may result in higher reimbursements.
Knowing the SSA Rules
There are 8 rules that determine if a patient discharged on Day 8 or earlier qualifies for a SSA. CarePoint therapy management software tests for compliance with 5 of these 8 rules automatically. Compliance with the 3 remaining rules must be confirmed with the MDS coordinator or nursing staff. The 5 rules CarePoint tests automatically are:
The Medicare Part A length of stay is 8 days or less.
Therapy started in the last 4 days of the stay.
At least 1 discipline treated or “planned to treat” on the last day of the stay.
The ARD must be the last day of the stay.
The ARD cannot be more than 3 days after the start of therapy.
Discipline day requirements are waived, i.e., two disciplines are not required for an RU RUG’s level. SSA rules may apply to any length of stay (“LOS”) that is 8 days or less.
Managing RUG’s Levels for SSA’s
Patients qualifying for SSA’s may achieve higher RUG’s levels for the days on caseload as defined by the LOS. If qualified, the RUG’s level is based on the average therapy minutes provided over the LOS. Reimbursement for the days the patient was on caseload is at the therapy RUG’s level. Reimbursement for days without therapy before the evaluation date is limited to the non-case mix level. The average therapy minutes required to achieve a specific RUG’s level are:
RL = 15 - 29 minutes
RM = 30 - 64 minutes
RH = 65 - 99 minutes
RV = 100 - 143 minutes
RU = 144 or > minutes
Definition of Length of Stay
The LOS is from the "first evaluation date” to the "last treatment date" or the “ARD date,” whichever is later, for all patients discharged on Day 8 or earlier. This definition extends the LOS calculation to the fourth day of the stay when no treatment was provided since the ARD date must be the last day of the stay for the patient to qualify for a SSA.
Definition of Last Day of the Stay
The last day of the stay is used to define some of the 5 rules that determine if a patient qualifies for a SSA. The last day of the stay is the "last treatment date" or the “ARD date,” whichever is later. This definition extends the last day of the stay to include a day when treatment was “planned” but not provided if that day is the last day of the stay.
These definitions ensure that CarePoint is consistent with the interpretation of Test 3 by CMS relating to the inclusion of the last day of the stay with only “planned” treatments in the LOS. If the patient is treated on the last day of the stay, the RUG's level could be higher because of the affect those treatments might have on the average therapy minutes provided.
Complex Analyses Made Easy
Therapy managers are far too busy and face too many challenges to be expected to “analyze” complex SSA qualifying rules, compute alternative RUG’s levels, and determine the appropriate RUG’s level reimbursement each day. They require simple and effective tools to manage the SSA qualifying process so they can focus on providing high quality patient care.
CarePoint therapy management software provides therapists with tools to plan, schedule, and enter treatments; identify patients who may qualify for a SSA, test the 5 qualifying rules automatically, and compute the highest RUG’s level that is medically appropriate.