Certified Revenue Cycle Representative (CRCR) Practice Exam

What is required for a Medicare beneficiary to receive skilled nursing care?

1. Previous outpatient services for 2 days

2. Medically necessary inpatient services for 3 consecutive days

3. Emergency room treatment within the last month

4. A valid referral from a primary care physician

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

To qualify for skilled nursing care under Medicare, a beneficiary must have received medically necessary inpatient services for three consecutive days. This requirement ensures that the individual has undergone a hospital stay with skilled services that justify the need for continued care in a skilled nursing facility (SNF). The three-day inpatient stay must precede the admission to the skilled nursing facility and is crucial because it establishes a patient's medical condition requiring further rehabilitation or recovery. Medicare policies stipulate that the care received in a hospital must be related to the same condition for which skilled nursing care is being sought. This is designed to ensure that beneficiaries only access SNF care when it is medically necessary post-hospitalization, thereby maintaining quality standards and managing costs associated with Medicare services. The other options presented do not meet the specific requirements established by Medicare for skilled nursing care. While outpatient services, emergency room treatments, or physician referrals might be relevant in other healthcare contexts, they do not fulfill the necessary criteria for access to skilled nursing care under the guidelines of Medicare.