The Inpatient Psychiatric Facility (IPF) Interrupted Stay is a specific administrative and billing rule established by Medicare under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). This regulation tracks a patient’s continuous episode of care, which directly affects facility reimbursement. Proper tracking ensures compliance and maintains a record of continuous treatment, even when a patient must temporarily leave the facility.
Defining the IPF Interrupted Stay
The Interrupted Stay policy is a provision within the Centers for Medicare & Medicaid Services (CMS) guidelines governing the IPF PPS. An interrupted stay occurs when a patient is discharged from an IPF and is subsequently readmitted to the same or another IPF within a short, defined timeframe. This rule applies whether the patient is temporarily discharged to home, an acute care hospital for medical treatment, or another facility. The core purpose is to treat the pre-interruption and post-interruption periods as a single, continuous stay for billing purposes.
This framework recognizes that temporary medical needs or therapeutic leaves may require a patient to leave before psychiatric treatment is complete. If the absence meets the criteria, the facility submits a single, combined claim for the entire episode of care. The rule also applies when a patient is transferred to another IPF within the specified time limit, ensuring the variable payment adjustment sequence is not reset.
The Critical Time Window for Return
The short-term timeframe defining an absence as an interruption is precisely set at three calendar days. For the stay to be classified as interrupted, the patient must be readmitted to an IPF before midnight on the third consecutive day following the initial discharge. This three-day window keeps the original stay intact, tying the two separate periods of inpatient care together.
The day counting process begins on the calendar day of discharge, which is counted as day one. Days two and three immediately follow the discharge day. If the patient returns up until 11:59 p.m. on the third day, the stay is continuous; otherwise, the readmission is treated as a completely new stay.
Financial Implications for Payment
The Interrupted Stay definition carries significant financial weight due to how the IPF PPS calculates payment. The system uses a federal per diem rate, adjusted by a variable factor that decreases as the patient’s length of stay increases. This variable adjustment recognizes that facility costs are higher at the beginning of a stay due to initial assessments and treatment planning.
Treating the interrupted stay as continuous prevents the facility from resetting the variable per diem adjustment upon the patient’s return. If billed as a new admission, the facility would receive the higher payment associated with the first few days of care again. Continuity ensures that upon readmission, the payment schedule resumes at the rate it would have been had the patient never left, reflecting the true length of the overall treatment episode.
Interrupted Stay vs. New Admission Status
The distinction between an interrupted stay and a new admission status is governed by two different regulatory time limits. The short-term, three-day window determines if a temporary absence is continuous for the variable per diem adjustment. A separate, long-term regulatory boundary defines the maximum time a patient can be absent before the original stay is definitively terminated, requiring a new admission process.
While CMS does not explicitly define a single long-term boundary for all IPF stays, the patient’s coverage limits act as the ultimate boundary. For patients in distinct part units of acute care hospitals, the coverage period is tied to a set number of days per illness, plus a separate lifetime reserve. An absence exceeding the short-term window, or one that pushes the patient past their benefit period, results in the subsequent readmission being classified as a new admission.