Does Midnight Rule exception apply if Resident leaves AMA?

Specialties MDS


Generally, the day of discharge, death, or a day on which a patient begins a leave of absence, is not counted as a utilization day. (See the Medicare Benefit Policy Manual, Chapter 3, "Duration of Covered Inpatient Services.") This is true even where one of these events occurs on a patient's first day of entitlement or the first day of a provider's participation in the Medicare program. In addition, a benefit period may begin with a stay in a hospital or SNF, on that day.

exception to the general rule
of not charging a utilization day for the day of discharge, death, or day beginning a leave of absence is where the patient is admitted with the expectation that he will remain overnight but is discharged,
, or is transferred to a nonparticipating provider or a nonparticipating distinct part of the same provider before midnight of the same day.
In these instances, such a day counts as a utilization day
. This exception includes the situation where the beneficiary was admitted (with the expectation that he would remain overnight) on either the first day of his entitlement or the provider's first day of participation, and on the
same day
he was discharged,
, or transferred to a nonparticipating provider.

Can this rule apply if the Resident admits and then leaves AMA?

Specializes in ER CCU MICU SICU LTC/SNF.

With concise documentation that the patient's discharge to home is deemed unsafe and patient signs AMA -- yes.

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