CMS Pub. 100-04, ch. 1, § 130.3.3

Last Bill Reported Patient Status as Still Patient (30)

(Rev. 1472, Issued: 03-06-08, Effective: 05-23-07, Implementation: 04-07-08)

Where the patient does not return from a leave of absence, regardless of the reason, the

SNF must submit a discharge bill showing the date of discharge as the date the individual

actually left. If the patient status was reported as “30” (still patient) on an interim bill and

the patient failed to return from a leave of absence within 30 days, including the day

leave began, or has been admitted to another institution at any time during the leave of

absence, the SNF must submit an adjustment request to correctly indicate the day the

patient left as the date of discharge. (A beneficiary cannot be an inpatient in two

institutions at the same time.) This closes the open admission on the patient’s utilization

record.

NOTE: Home health or outpatient services provided during a leave of absence do not

affect the leave and no discharge bill is required.

EXAMPLE l:

The beneficiary goes on a leave of absence on January 3, expecting to return on January

10. On January 6, the SNF receives word that the patient died on January 5. The SNF

submits a discharge bill showing January 3 as the date of discharge.

EXAMPLE 2:

The beneficiary goes on a leave of absence on February 6, expecting to return on

February 12. However, the beneficiary does not return on February 12 as expected and

the SNF cannot determine whether the beneficiary will return. The SNF submits a

discharge bill showing February 6 as the date of discharge as soon as practical, or after 30

days have elapsed from the day the leave began. If an interim bill had been submitted

showing the beneficiary in “still patient” status as of February 6 or later, the SNF submits

an adjustment request showing February 6 as the discharge date. The advantage of

delaying the discharge bill for 30 days is that it will make unnecessary a new admission

notice in the event the beneficiary returns before 30 days have elapsed.

EXAMPLE 3:

The beneficiary goes on a leave of absence on March 4, and is expecting to return April 1

but does not. The SNF submits a discharge bill showing March 4 as the date of discharge

since the beneficiary did not return within the 30-day period.