This is from the Medicare Benefit Policy Manual Chapter 8
Coverage of Extended Care (SNF) Services Under Hospital Insurance http://www.cms.hhs.gov/manuals/Downloads/bp102c08.pdf
p35, last paragraph
"The “practical matter” criterion should never be interpreted so strictly that it results in the automatic denial of coverage for patients who have been meeting all of the SNF level of care requirements, but who have occasion to be away from the SNF for a brief period of time. While most beneficiaries requiring a SNF level of care find that they are unable to leave the facility, the fact that a patient is granted an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.
Where frequent or prolonged periods away from the SNF become possible, the intermediary may question whether the patient’s care can, as a practical matter, only be furnished on an inpatient basis in a SNF. Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences." Billing:
If resident is not in facility on the midnight of LOA, Medicare cannot be billed for that day, nor the day of LOA be deducted from resident's Medicare benefit days. The patient can be billed for that LOA if prior agreement between facility and patient has been made. If there is no prior agreement, the facility will shoulder the cost for that day.
This is from a Fiscal Intermediary: LOA Special Billing Instructions:
• Regular billing cycle (month)
• LOA days indicated as noncovered days
• 74 occurrence span code with dates patient was on LOA
• 018X revenue code with the appropriate number of LOA days and both charges fields (total
and noncovered) left BLANK.
• 0022 revenue codes with HIPPS codes (as applicable)
• Accommodation revenue code(s) and charges, not including LOA days
As seen in the special billing instructions above, LOA days are treated as noncovered days, but noncovered charges do not appear on the claim.