I worked in a RHC and we did many inpatient to swing beds on the same day. Technically, yes - you can bill both a discharge and admit on the same day and that is clearly stated in the policy. The catch is there needs to be documentation to support both services. When auditing I would look for a discharge note (handwritten or dictated) as well as an admission note that meets the requirement to bill a admit (using the nursing home codes). Unfortunately, this is where I found the problem and could rarely get supporting documentation to report both services. I usually got a discharge note but the admit would fall short of the required elements to report the lowest level admission (for a level 1 admit you need at least a detailed history, detaied exam and low MDM).
As far as having this in writing - my point was always back to the basic "not documented, not done". You can bill out both but it would never be acceptable to bill out for a service that is not supported by documentation.
does that make sense?
Hope this helps some !
Christie Musser, CPC
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