Hi Sally. Here is the reference in the new Medicare Benefit Policy Manual: http://www.cms.gov/manuals/102_policy/bp102c08.pdf Look at 20.2 for the description and examples. We typically write a telephone order to clarify 'deferred therapy' status at the time of admission. However the hospital records and transfer orders are usually pretty clear with regards to weight-bearing status so I'm not sure that's necessary for us to do, but I don't think it hurts to clarify the status. At that time, if we need to, we get an estimate of time from the doctor. Yes, you can do other skilled interventions, such as upper extremity strengthening or transfer training, etc. Many times there are skilled nursing services such as IV antibiotics or wound care also. Hope this helps, Winona
-----Original Message----- From: Sally Murphy [mailto:[EMAIL PROTECTED] Sent: Monday, November 17, 2003 7:56 PM To: [EMAIL PROTECTED] Subject: Deferred Medicare Coverage 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 /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
