Inpatient respite care is provided to the beneficiary only when necessary to relieve the family members or other caregivers that are caring for the beneficiary at home. Coverage for respite care does not require a worsening of the beneficiary’s condition. Respite care is short-term inpatient care and is reimbursed for no more than five consecutive days per respite period. This care is provided on an occasional basis. Any number of situations may necessitate respite care.
Examples of appropriate use of respite care:
Examples in which respite care is not appropriate:
Supportive Documentation for Respite Care
The medical record must show when the level of care was changed to respite care and the reason. The following an example of supportive documentation:
“Caregiver needs relief because beneficiary is keeping caregiver up all night; transfer to appropriate facility. Begin respite care 10 a.m. on 1/1/YY. Mary Nurse, R.N. Caregiver is able to care for beneficiary at home; transfer beneficiary to home on 1/4/YY at 12 noon. Mary Nurse, R.N.”
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