When Maryland hospitals attempt to discharge a fee-for-service Medicaid recipient to a lower level of care but are not able to, they may want to be reimbursed for “administrative days.” These are days of care for a patient who no longer needs acute inpatient care but must remain in the hospital for other reasons.
Administrative days place a hospital in an odd position. For example, a delay in placing a patient in long-term care can bring up payment issues. The facility is housing a patient, but cannot get its payment tied to acute inpatient care because such care is not medically necessary.
Some hospitals lose a significant amount of money because they are not reimbursed for administrative days. In many cases, administrative days are just not requested. In others, the documentation falls short.
In order to avoid medical necessity denials that translate into lost payments, it is important that hospitals in Maryland understand the requirements of the Maryland Medicaid Program for requesting administrative days.
Administrative days may occur for several reasons. When a patient has been stabilized but requires inpatient rehabilitation, there are often barriers to immediate placement. Many long-term care facilities simply do not have room for the patient. Our office recently had a case where the patient was a minor who suffered injuries in a motor vehicle accident. Due to the age of the patient, her long-term care options were limited, and the hospital had to call multiple facilities to find one that accepted minors. Even for adult patients, hospitals may have to make several calls to find a bed in a long-term care facility.
Once the hospital finds a long-term care facility that can accept the patient, that facility will then have to get authorization to treat the patient. This process does not take place overnight. Because the long-term care facility cannot give the patient a spot until it is authorized to treat the person, the patient’s move will likely be delayed. Typically a day or two is spent after the hospital calls the new facility and before the latter gets authorization. We have seen cases where it has taken a month or more to place a patient, and none of the days were paid because of this issue.
In sum, a patient with ongoing needs sometimes cannot be discharged immediately, even after acute inpatient care is no longer medically necessary. Therefore, it is important to understand how to request reimbursements for administrative days.
Requesting administrative days
The regulatory requirements for administrative day reimbursements can be found in COMAR 10.09.92.07(C) (http://www.dsd.state.md.us/comar/comarhtml/10/10.09.92.07.htm). The Maryland Department of Health has issued Hospital Transmittal No. 258 to clarify and outline the process for requesting administrative days. According to the department, “administrative days should be requested for days when a provider has sought placement for a patient who remains inpatient but no longer needs an acute level of care.”
Document placement efforts
During the stay, the hospital should continue to provide concurrent stay reviews as normal. Maryland Department of Health Transmittal No. 258 requires a hospital to make a minimum of two calls per day to show attempts to place the patient. Hospitals often get tripped up by this rule. A common mistake is for hospitals to place a call once every few days when they should be making two calls a day and document these attempts clearly in the patient’s medical record.
MDH Form 1288, attached to Transmittal No. 258, provides a log for tracking placement efforts (https://mmcp.health.maryland.gov/MCOupdates/Documents/pt_26-18.pdf). At the time of the retrospective review, the hospital should submit a completed MDH Form 1288, including a completed log, detailing placement efforts.
It should be noted that administrative days are paid at a discounted rate. For fiscal year 2021, the Maryland Medical Assistance Program will pay $275.14 per day for most administrative days . This payment is typically much less than the cost of an acute inpatient bed. However, not properly requesting administrative days can result in a denial and non-payment. Our office has seen cases where a hospital failed to request administrative days and received no payment for an acute hospital stay that was no longer medically necessary.
Document changes in patient status
In order to ensure your hospital gets paid for administrative days, documentation is key. Keep in mind that a patient’s status can change every day. If acute inpatient care is not medically necessary on one day, such care could still be needed on the next day if the patient takes a turn for the worse. For days when acute inpatient care is medically necessary, document the reasons it was appropriate. For days when the patient is stable and awaiting placement, be sure to document placement efforts. Doing so will save both time and money in the future.
Note: This article refers specifically to the Maryland Medical Assistance Program. For discharge conflicts with commercial and managed care plans, refer to our blog, “NOT Medically Necessary BUT Reimbursable.”
Anderson & Quinn, LLC is a law firm based in Rockville, Maryland, providing individuals, businesses, corporations, and healthcare institutions with the legal and litigation support they need to protect revenues. Jason Anderson is an associate at Anderson & Quinn, LLC, 25 Wood Lane, Rockville, MD, 20850. Tel: 301-762-3303. Email: janderson@andersonquinn.com.
