CMS Pub. 100-02, ch. 3, § 20.1.1

A3-3103.2, A3-3135.2, HO-216.2, SNF-242.2

When a patient chooses to continue to occupy hospital or SNF accommodations beyond

the checkout time for personal reasons, the hospital or SNF may charge the beneficiary

for the continued stay. Such a stay beyond the checkout time, for the comfort or

convenience of the patient, is not covered under the program, and the hospital's or SNF's

agreement to participate in the program does not preclude charging the patient. However,

the hospital must provide the beneficiary with an Advance Beneficiary Notice (ABN)

before the noncovered services are provided. See Medicare Claims Processing Manual,

chapter 30, for instructions about ABNs.

Where the patient's medical condition is the cause of the stay past the checkout time (e.g.,

the patient needs further services, is bedridden and awaiting transportation to their home

or in the case of a hospital, transfer to a skilled nursing facility, or dies in the SNF or

hospital), the stay beyond the discharge hour is covered under the program and the

hospital or SNF may not charge the patient.

The imposition of a late checkout charge by a hospital or SNF does not affect the

counting of days for:

• Ending a benefit period;

• The number of days of inpatient care available to the individual in a hospital or

SNF; and

• The 3-day prior hospitalization requirement for coverage of post hospital

extended care services and Part A home health services.

A late charge by a hospital does not affect counting of days for meeting the prior

inpatient stay requirement for coverage of extended care services.

The Quality Improvement Organization is responsible for reviewing the appropriateness

of early discharges.