What Is Medicare’s 3-Day Inpatient Rule?
Short answer
Under the ordinary Original Medicare rule, Part A SNF coverage generally requires a qualifying inpatient hospital stay of at least three consecutive days before the SNF stay. Observation time generally does not count.
Coverage
A qualifying hospital stay is only one requirement. The beneficiary must also enter a Medicare-certified SNF within the applicable timeframe and need daily skilled care related to the hospital condition or another qualifying condition treated during the SNF stay.
Not Automatic
Some Medicare payment models or Medicare Advantage arrangements can waive the ordinary three-day requirement, so the rule should not be described as absolute in every case.
Practical Example
Two inpatient midnights plus one night of observation generally do not equal a three-day qualifying inpatient stay under the ordinary Original Medicare SNF rule.
Questions to verify
- Which hospital days were formally inpatient?
- Does a waiver apply?
- Does the SNF stay meet the other Part A requirements?