5D509: No Qualifying Hospital Stay Dates Were Shown in HIMR for This Skilled Nursing Facility Stay

Published 08/10/2022

Reason for Denial
The service(s) billed was/were not covered by Medicare, as there is no qualifying hospital dates shown in Health Insurance Maintenance Record (HIMR) for this skilled nursing facility.

To Prevent This Denial
The three consecutive calendar day stay requirement can be met by stays totaling three consecutive days in one or more hospitals. In determining whether the requirement has been met, the day of admission, but not the day of discharge, is counted as a hospital inpatient day. In addition, the qualifying hospital stay must be medically necessary.


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