Skilled Nursing Facility 3-Day Rule Billing

To qualify for Skilled Nursing Facility (SNF) extended care services coverage, Medicare patients must meet the 3-day rule before SNF admission. 

The 3-day rule requires,

• Three-day-consecutive inpatient hospital stay. 
• Three-day-consecutive stay counts inpatient setting.
• Starting with the calendar day of hospital admission.
• Doesn’t include the day of discharge or any pre-admission time spent in the ER or outpatient observation.

SNF extended care services are an extension of care a patient needs after a hospital discharge or within 30 days of their hospital stay (unless admitting them within 30 days is medically inappropriate).

Example

A 68-year-old male patient went to the hospital ER after falling on May 17th from his home and a physician admitted him to the hospital on the same day. On subsequently May 20, the hospital discharged him to SNF extended care services. 

For this case, the patient did qualify the 3-day rule. Hospitals can count the admission day (May 17th to May19th), but not the discharge day (May 20). 

Tips

Medicare considered inpatients meet the 3-day rule by staying 3 consecutive days in 1 or more hospital(s) as well.

See Inpatient Guidelines