Ask the care expert: do emergency room stays count toward Medicare Part A three-day hospital stay?

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Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

Does the three-day hospital stay start when the resident reaches the emergency room?

No! The three-day hospital stay for the requirement to take advantage of the Medicare A benefit starts when the resident is admitted to his or her room.

No matter how long he or she is in the ER, that period does not count toward the required time. Also, any “observation period” does not count. If a hospital decides to observe the resident in the ER or an observation room, this time does not count toward the three days.

And, in case you were wondering,  the day of discharge does not count either. So in one scenario, you could have a resident spend two days in the ER for observation, get admitted to a room for three days, and then be discharged on the third day. Although he or she has been out of your facility for five days, the resident would only have two of the three days needed to qualify for Medicare A benefits.

Does H1N1 get coded on the MDS in section W?

There is a lot of information about the flu right now. The Centers for Medicare & Medicaid Services recommends going to www.cdc.gov for the latest. If you need information about billing for supplies with regard to the flu vaccine, needles, etc., visit www.cms.hhs.gov/H1N1. You will see billing downloads and billing information.

Seasonal flu shots should be coded in Section W of the MDS. H1N1 should NOT be coded on the MDS.
Also, CMS does not lock out dates on the computer with regard to the flu shot dates. If you are having trouble entering dates in section W on your system, check with your software vendor, as it is not a lockout from CMS.