The Department of Health requires nursing homes to complete electronic filing of each facility’s licensed nursing home beds and availability by bed category on a weekly basis. All nursing homes are requested to submit their Weekly Bed Census between Wednesday and Friday of each week, based on the census at 12:00 AM on Wednesday night. The Nursing Home Weekly Bed Census data is the most recent data available.
The midnight census is an extremely important component of accurate billing because it deals with what is often referred to as the “head-in-the-bed” or “Cinderella” rule, which requires a resident to be an inpatient at midnight in order for the facility to bill Medicare Part A for that day.
Although this information is not required when submitting a claim, auditors or reviewers can request documentation proving residents were actually inpatients at midnight for the days billed. Without this documentation, the auditor or reviewer may determine that the facility billed inappropriately and require that they return the money to Medicare.
Ultimately, facilities must protect their reimbursement with documentation proving they followed Medicare coverage and billing requirements. When it comes to the “head-in-the-bed” rule, the midnight census is a great way to collect the necessary documentation. Among other things, the midnight census documents the residents that were inpatients at midnight, thus supporting that the facility’s ability to bill Medicare Part A for that day. If the facility does not do a midnight census and does not collect the necessary information in any other way, their reimbursement dollars are at risk.