Billing Alert.

Q: I am a billing agent and have been telling my clients that if a skilled nursing facility (SNF) resident is out of the facility because of a leave of absence (LOA), the facility cannot bill the beneficiary for the bed hold. Some of my clients are challenging me on this issue and want proof from the Medicare regulations.

A: Refer your clients to the Internet-Only Manual, Publication 100-4, Medicare Claims Processing Manual, Chapter 6, starting with Section 40, "Special Inpatient Billing Instructions." This section defines when a resident is in a qualified LOA or has actually been discharged from the facility based on the Medicare regulations.

If the resident meets the definition of LOA, then you are correct in what you have been telling your clients: The SNF cannot bill the resident for days during the LOA period. This reference can be found in Section 40.3.5.2, which defines the LOA and gives examples and billing instructions for appropriately billing the LOA days on the UB-92.

From Billing Alert for Long-Term Care by Lee Heinbaugh, consultant, PMG, LLC (Cleveland), published by HCPro, Inc. (www.hcpro.com). Nursing Homes/Long Term Care Management bears no responsibility for the opinions/advice contained herein.