Skilled nursing facility (SNF) leave of absence
A leave of absence (LOA) is a situation where the skilled nursing facility (SNF) resident is absent at midnight census, but not discharged, for reasons other than admission to a hospital, other SNF, or distinct part unit of the same SNF. For example, the patient is in the emergency room, but not admitted, or the patient goes home overnight for a family event.
If the absence exceeds 30 consecutive days, the three-day qualifying hospital stay, and 30-day transfer requirements must be met to establish re-entitlement to SNF benefits.
Billing leave of absence
- LOA days are shown on the bill with revenue code 018X and LOA days as units. However, charges for LOA days are shown as zero on the bill:
- Occurrence span code 74 with from and through dates of leave
- Report days of leave as non-covered days (VC 81)
- Revenue code 0180
- Enter zero for the charges
- Units = number of LOA days
When the patient does not return from an LOA, regardless of the reason, submit a discharge bill with the date of discharge as the date the patient left/began their LOA.
If patient status “30” (still patient) was reported on an interim claim and the patient failed to return from an LOA within 30 days (including the day leave began) or admitted to another institution at any time during the leave of absence, submit an adjustment to correctly indicate the day the patient left as the date of discharge.
You cannot bill the beneficiary for leave of absence days.
You should review the resident assessment manual to clarify situations where an LOA is not appropriate; for example, observation stays in a hospital lasting greater than 24 hours.
If the LOA begins the first day of a month, the provider needs to combine both the prior month’s claim and the claim that the LOA occurred.
If the leave of absence occurs over the provider fiscal year end, then the provider must discharge the beneficiary and readmit.
- Provider fiscal year end is 09/30.
- SNF discharges the beneficiary 09/30 and then admits the beneficiary 10/01.