I've read thoroughly the 212.3 section of the SNF Manual regarding
Medical Appropriateness Exception for a Med A beneficiary who is not
going to be able to participate in therapy for more than 30 days due to
non weightbearing status of more than 30 days but I'm still confused.
Is the physician's statement on the discharge summary all that is
needed to take advantage of this, i.e., "I anticipate it will take 8 to
12 weeks for this fracture to heal and she will be nonweightbearing in
that time period" or does he need to say something more specific in
regard to Medicare? And is is all right to use a week or two of Med A
for surgical incision care and therapy to train staff in transfers and
set up restorative nursing for exercises and then give a Medicare Denial
until the time therapy can resume? How about the doctor who orders PT
for transfers and progressive strengthening with a nonweightbearing
order who doesn't mention how long the NWB is expected to last? Can we
still get an estimate of time from him after the patient is admitted?
Thanks,
Sally
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