Charging Nursing Home Residents to Hold Beds During the Holidays Is Not Proper

Often when a nursing home resident leaves for a short time, the facility will try to charge either the resident or Medicare/Medicaid for that short term absence. Those charges may not be proper. Family members need to understand there are requirements that the facility has to meet regarding these short absences. Often the facility will claim that the resident must be charged to hold the bed while the resident is out.

The Medicare Benefit Policy Manual is clear that a facility should not notify patients that leaving the facility will lead to loss of Medicare coverage.

Such a notification is not appropriate. The manual a;lso recognizes that although most beneficiaries are unable to leave their facility, 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 skilled nursing facility for the receipt of required skilled care. The Center for Medicare Advocacy reports that residents in nursing homes- long term skilled nursing facilities can leave the nursing home during this holiday season without losing their Medicare coverage. Generally, if the resident returns to the facility by midnight, the facility can bill Medicare for that day’s stay.

If the resident is gone overnight (i.e., past midnight) and returns to the facility the next day, the day the resident leaves is considered a leave of absence day. While the facility cannot bill Medicare for leave of absence days, it is today unclear whether the facility can bill the beneficiary for those days.

As the Center for Medicare Advocacy has reported in prior years, Chapter 6 of the Medicare Claims Processing Manual says that the facility cannot bill a beneficiary during a leave of absence. However, a provision in Chapter 1 of the Medicare Claims Processing Manual, issued May 30, 2008, authorizes skilled nursing facilities to bill a beneficiary for bed-hold during a temporary “SNF Absence” if the nursing home informs the resident in advance of the option to make bed-hold payments and of the amount of the charge and if the resident “affirmatively elect[s]” to make bed-hold payments prior to being charged. The Center for Medicare and Medicaid Services confirms that “a facility cannot simply deem a resident to have opted to make such payments and then automatically bill for them upon the resident’s departure from the facility.

It is always a good idea to coordinate with the facility when you want to take a loved one out. Knowing these provisions will help you stand up for the rights of your loved ones if a facility tries to charge you improperly.