The 3-Overnight Rule Waiver

Did you know that CMS allows Medicare Advantage plans a waiver for the 3-overnight rule for SNF placement? Many Medicare Advantage plans utilize this benefit and will allow patients with a skilled need to be authorized for a SNF admission and gain access to their Medicare A benefits. 

What does this mean for you? As a SNF service provider, you must verify benefits for Medicare Advantage members prior to admission. When you are completing verification, be sure to ask if a 3-overnight stay is required. If you are told no, then you can proceed to requesting authorization.

Working with hospital emergency rooms or physician’s offices can be easier if you know the waiver rule as well. It is a big win when you are known as the SNF that educates the ER and works with them to admit from the ER or the physician’s office to the facility.  Admissions from the ER or a physician office require documentation similar to that of an admission from home: most current H&P, physician order, med lists and documentation supporting the skilled need. This documentation provides the reasoning why a lower level of care is not sufficient for the patient. 

This also means that if you have a long -term care resident who has a Medicare Advantage plan and acquires a new skilled need (i.e.; IV antibiotics q8 for pneumonia), you can request a skilled authorization for that patient’s care in house with no need for hospitalization. Please note that the 60-day wellness break still applies and the patient must have Medicare A days available.