I have a long standing case where a resident was denied Medicare coverage by
our facility due to no longer skilled status. Our FI agreed, beneficiaries
husband has appealed a few times and each time decision was made that agreed
with us. He is working with the center for Medicare advocacy who is trying
to tell me that G tube flushes are a skilled service according to the Code
of Federal regulations section 409, 33b2, - I asked her if she referred to
the Medicare Beneficiary Policy manual and she said that the CFR "overruled"
this. I tried to explain to her that the CFR was the rules SNF had to
follow, not the determination for skilled care based on Medicare guidelines
from CMS for Medicare Coverage. I need a little assurance / back up when I
go to the hearing about this December 11. Please Please Please can someone
help me out?
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