Without getting bogged down in the LTC debate, I have an issue with @DTorok's suggestion of making LTC visits one day long when the visit_end_date is not specified.
From the claims perspective, there are two types of claims submitted while a patient is in long-term care - one from the doctor and one from the facility (where the patient actually resides). Doctors not contracted with the facility submit bills on their behalf. Those services last one day (i.e. evaluation/management visits that check on the general status/well being of the patient). And I am ok with setting those visit_end_dates = visit_start_dates since the length of time for that service is always within a day.
However, you should not make visit_end_dates = visit_start_dates for facility claims. Some facility claims are billed on a monthly basis (SNF reference here and (section 40) Medicare SNF Billing Manual; Hospice billing reference - section 90 (Medicare Hospice Facility Billing)) when a patient is in a skilled nursing facility (i.e. rehab after an acute inpatient setting) or hospice. Sometimes these patients can be in the SNF/hospice for months at a time. These facilities bill for the patient services by month and do not put in a discharge date because the patient is still in the SNF/hospice. However, the facility will bill using the start and end of the month to indicate the invoice date for the services charged. For these claims, I suggest using the claim's billing start and end date as the visit start/end dates. This is because:
- Line items services (i.e. services attached to revenue codes) will have dates throughout the month. These services should be within the visit occurrence record's start/end dates. If we were to set the visit_start_date = visit_end_date, you are going to get revenue codes/services (i.e. procedure_occurrence records) from the facility claim that are outside of that imputed one day visit. And that doesn't make sense to anyone.
- This monthly visit record is more in line with what actually happened. The patient was in the facility for that month. So the facility is billing services (i.e. room and board services, nursing services, etc.) for that month.
I know there are other ideas of handling LTC visits, but imputing one-day events for LTC facility claims is problematic. And I suggest using the claim invoice dates (aka claim billing dates, claim dates - as named in other data sources) for visit_end_dates because that is the best information available to the user.