TX HHS Form 3619. Medicare/Skilled Nursing Facility Patient Transaction Notice

The TX HHS Form 3619, Medicare/Skilled Nursing Facility Patient Transaction Notice, is a document used to record patient transactions between hospitals, nursing facilities, and other healthcare providers. This form helps solve the problem of tracking patient movements and ensuring accurate billing for Medicare-covered services.

This form requires information such as the Medicaid recipient's number, social security number, and Medicare claim number, as well as details about the patient's stay, including admission and discharge dates, and the type of care received. The "Comments" section allows administrators to provide additional explanations or clarification for transactions that do not meet the standard 20-day qualifying stay requirement.

The form should be used whenever a patient is admitted to or discharged from a skilled nursing facility or hospital, and Medicare coverage is involved. It is essential to accurately complete this form to ensure proper reimbursement and compliance with Medicare regulations. The administrator's signature certifies that the transaction dates are accurate and do not fall within the 100% Medicare Part A reimbursement time frame.