Certified Revenue Cycle Representative (CRCR) Practice Exam

Coverage rules for Medicare beneficiaries receiving skilled nursing care stipulate that the beneficiary must have received what prior to admission?

1. Physician referrals and outpatient therapy

2. Medically necessary inpatient hospital services for at least 3 consecutive days

3. A physical examination and consent forms

4. Any type of inpatient care regardless of duration

The correct answer is: Medically necessary inpatient hospital services for at least 3 consecutive days

For Medicare beneficiaries to qualify for coverage of skilled nursing care, they must have had a prior inpatient hospital stay that meets specific criteria. The requirement states that the beneficiary must have received medically necessary inpatient hospital services for at least three consecutive days before being admitted to a skilled nursing facility. This is crucial because it ensures that the care provided in the skilled nursing facility is a continuation of the acute care received in the hospital and is medically justified based on the patient's condition and needs. This requirement acts as a safeguard to ensure that services provided are appropriate and necessary, serving to prevent unnecessary costs to Medicare by confirming that beneficiaries arriving at skilled nursing facilities have a legitimate medical need following a hospital stay. The focus on a minimum of three days distinguishes this requirement from other potential forms of care, ensuring that beneficiaries have received an adequate level of care preceding their skilled nursing treatment.