COVID-19 changes: CMS updates 3-day rule

The Centers for Medicare & Medicaid Services (CMS) has waived the 3-midnight rule during the COVID-19 pandemic. Here’s what you need to know:

• This update does not necessarily apply to every patient.
• This rule applies to beneficiaries who are affected by the coronavirus, such as those who are “evacuated from a nursing home in the emergency area, discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency.”
• The resident must meet skilled criteria.
• This is retroactive to March 1, 2020.
• Your billing needs to include the “DR” condition code to allow CMS to track these stays.

The official guidance can be found here https://www.cms.gov/files/document/coronavirus-snf-1812f-waiver.pdf.