CMS Pub. 100-04, ch. 3, § 190.7.1

An interrupted stay is a case in which a patient is discharged from an IPF and is

readmitted to the same or another IPF before midnight on the third consecutive day

following discharge from the original IPF stay.

For a patient who is discharged and readmitted to the same IPF, interrupted stays are

considered to be continuous for the purposes of applying the variable per diem adjustment

and determining if the case qualifies for an outlier payment. In other words, an interrupted

stay is treated as one stay and one discharge for the purpose of payment. Thus, the IPF

should hold the claim for 3 days to ensure there is not a readmission that soon. In this

way, the readmission is included on the original claim.

For example, if a patient leaves the IPF on 1/1 and returns to the same IPF on 1/3, this is

considered an interrupted stay and the Occurrence Span Code 74 will show 1/1 – 1/2.

Should the patient return to the IPF on 1/4, two bills are allowed.

For a patient who is discharged and readmitted to another IPF, interrupted stays are

considered to be continuous for the purposes of applying the variable per diem adjustment.

For example, if a patient is discharged from IPF “A” and within 3 days is readmitted to

IPF “B,” this is considered an interrupted stay under IPF PPS. There will be no provider

action. FISS will process the claim from IPF “B” with information received from CWF

on covered days from the claim received from IPF “A”(this information will be displayed

in FISS with a value code 75 on claim that is processed for IPF “B”).

Medicare contractors should monitor trends to ensure IPFs are not consistently admitting,

discharging, and readmitting patients in order to receive the larger variable per diem

payments associated with the first days of a patient’s stay.