Ala. Admin. Code r. 560-X-22-.08
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-22-.08 - Patient Days(1) A patient day is incurred when any one of the following conditions have been met: (a) Care is rendered to a patient in the facility. This results when a patient is rendered services between the census taking hour (12:00 midnight) on two (2) successive days. The following procedure illustrates the proper method of determining the number of patient days resulting from care rendered to patients in the facility, using the midnight census method: 1. Number of patients in the facility at midnight. 2. Add/subtract patients admitted/discharged (including deaths) prior to midnight of the following day (Exception - a patient admitted and discharged on the same day counts as a patient day.) The provider may bill for the date of admission, but not for the day of discharge. (b) When preadmission payments are received to ensure a bed is kept open for a particular patient. The rationale for including these payments lies in the fact that this bed is not available for occupancy by another patient. Since the facility is receiving payment for a bed which is, in effect, unavailable to any other patient, it should be included in patient day totals. (c) When a patient is out of the facility, regardless of the reason, and the nursing facility is receiving payment for the bed, this day is counted in the same manner as preadmission payments as stated above. If the nursing facility is not receiving payment for the bed, it will not be counted as a patient day. (d) Medicaid payment will only be made for therapeutic visits not to exceed three (3) days per visit and six (6) such visits per patient during any twelve-month period. Visits are limited to two (2) per calendar quarter to home, relatives, and friends. Limitations do not apply to patients in institutions for the intellectually disabled or persons with related conditions. The long-term care facility must ensure that each therapeutically indicated visit by a patient is authorized and certified as necessary by a physician. (See Schedule 8-A at end of chapter.)(2) Minimum records required to be kept at the facility are: (a) Midnight census by patient name at least one time per calendar month. More frequent census taking is recommended. (b) Ledger of all admissions and discharges/deaths. (c) Complete therapeutic leave records. (d) A monthly analysis sheet which summarizes all admissions and discharges, paid hold bed days, and therapeutic leave days. (Schedule 8-A at end of chapter is the recommended analysis sheet; however, providers may utilize any form of their own design if it provides the same information.) (3) In the event that payment for a preadmission day is not received and the charges are subsequently written off as uncollectable, the facility will not count those days as patient days. The facility must keep a separate ledger to indicate days in this category. The ledger must indicate the following: (b) Dates of preadmission days charged, (c) Dates of preadmission days written off as uncollectable, (d) Reason for uncollectability.Ala. Admin. Code r. 560-X-22-.08
Rule effective 10/1/1982. Amended effective 5/15/1983; August 10, 1983; October 1, 1990.Amended by Alabama Administrative Monthly Volume XLII, Issue No. 04, January 31, 2024, eff. 3/16/2024.Author: Sandra Johnson, Director, Provider Audit
Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§ 447.200 - .272, et seq.