CMS Pub. 100-04, ch. 6, § 40.3.3

The day of admission counts as a utilization day, except in the situation where the patient

was admitted with the expectation that he remain overnight but was transferred to another

participating provider before the following midnight. In this instance, the first provider

completes the bill as follows:

• Indicate “0” in Covered Days;

• Insert condition code “40” to indicate the patient was transferred from one

participating provider to another before the midnight immediately following the

admission to the first provider; and,

• Admission date, statement “from” and “through” dates are the same.

No payment is made to the originating participating provider. Instead, the participating

provider to which the patient was transferred counts the admission day as a utilization

day that includes the day of admission and may bill the HIPPS default code.

If a patient is transferred from a Medicare participating facility to a nonparticipating

facility the day of admission counts as a utilization day and the Medicare-participating

facility may bill the HIPPS default code.

These general rules apply to transfers between SNFs and between a hospital and an SNF.

However, under these same circumstances, if the two providers represent an institution

composed of a participating hospital and a distinct part participating SNF, the first

provider cannot bill for accommodations, but may bill for ancillary charges.