Medicare and leaves of absence

  1. Does anyone know the reg about a patient on Med A leaving the building for hours at a time. I don't mean for an MD appointment...I mean to go hang out with his friends. We called Medicare but the person we spoke to couldn't answer.
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  2. 3 Comments

  3. by   Talino
    "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." Medicare Benefit Policy Manual Chapter 8 p35
  4. by   CapeCodMermaid
    In his case, 'frequent and prolonged' are from noon till 9pm every day. I think it's time for him to go.
    Thanks for the information.
  5. by   Nascar nurse
    Quote from CapeCodMermaid
    In his case, 'frequent and prolonged' are from noon till 9pm every day. I think it's time for him to go.
    Thanks for the information.
    Oh my, I would say it's time to go too. We always tend to be pretty liberal with time spent out of the facility while on Med A, but this is really just for the couple hours at home once or twice a week.

    We've had some that we have to tell that they have to be in the facility by midnight and they come skating in the door at 11:59pm like a bad teenager. They get issued a non-covered letter pretty quickly. If you can party...you can party at home.

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