CMS Pub. 100-02, ch. 8, § 20.1.1

Regardless of whether a foreign hospital stay is itself coverable under the heading of

“foreign hospital services” (see Pub. 100-04, Medicare Claims Processing Manual,

chapter 32, §§350ff. for a description of the foreign hospital services that are payable by

Medicare), an inpatient stay of 3 or more days in a hospital outside the United States may

nevertheless satisfy the prior inpatient stay requirement for post-hospital extended care

services within the United States as long as the foreign hospital can qualify as an

“emergency hospital” (see Pub. 100-01, Medicare General Information, Eligibility, and

Entitlement Manual, chapter 5, §20.2, for the definition of an emergency services

hospital). If a stay of 3 or more days in a hospital outside the United States is being

considered to satisfy the prior inpatient stay requirement, the SNF will submit

documentation to the A/B MAC (A). This evidence will be either:

A. An itemized bill or hospital form prepared by the foreign hospital showing dates

of admission and discharge and a description of the illness or injury treated

(obtained from the beneficiary); or

B. A medical report prepared by the foreign hospital and sent to the patient’s U.S.

physician showing dates of admission and discharge and a description of the

illness or injury treated (obtained from the physician).

If neither type of evidence can be obtained, the SNF will secure whatever information is

available for submission to the A/B MAC (A). When the A/B MAC (A) receives a bill

involving a prior inpatient stay in a foreign hospital, it contacts the regional office for a

determination as to whether the prior stay requirement is met. If the regional office states

the hospital does not qualify as an “emergency hospital,” the A/B MAC (A) advises the

provider that the prior inpatient stay requirement is not met.

If the regional office states the hospital qualifies as an “emergency hospital” and

documentation is submitted as outlined in either §§20.2.1 or 20.2.2 which otherwise

meets the prior-stay requirement, the A/B MAC (A) processes the SNF claim.