Re: Tubefeeders

[Corey]

In that situation, the patient is skilled the entire time, unless the biller goofed when they d/c'd from medicare originally.   To the best of my knowledge, if the patient receives tube feeding during the time remaining in the facility, the skilled care period continues.  Below is a copy of a note about billing to indicate that the tube feed skilled care period stopped, and the CMS documentation.  I would assume that if a previous biller indicated that, the coverage period might begin again, but we would know it wouldn't.  I have not heard of re-starting Medicare coverage for another diagnosis despite not having a 60 day period of non-skilled coverage.  Maybe your patient was being trained to administer their own T.F.? (unlikely, but possible!)  This letter was dated 9/29/03:   >>Just found this post from Rena from some time back.....   This is a reminder from UGS, a Fiscalo Intermediary.  It applies to all SNFs, not just UGS' facilities. Rena <<QUOTE>> Reminder: Skilled Nursing Facility (SNF) and Hospital Swing Bed Providers Are To Submit a Claim Whenever the Beneficiary Ceases to Require a Skilled Level of Care CMS Letter dated June 9, 2003 It has come to our attention that once a beneficiary has exhausted his/her benefits, many SNFs are not submitting a bill to indicate when the beneficiary ceases to need skilled care. This memorandum serves to remind you that a bill is required whenever the beneficiary ceases to need skilled care, whether or not said beneficiary has any Medicare benefits remaining. This is necessary for the Common Working File (CWF) to correctly calculate the spell of illness. Instructions to this effect are in the Medicare SNF Manual in the second paragraph of �527. Providers are to show the end of the need for skilled care by using occurrence code (OC) 22, Date Active Care Ended, in the appropriate form locator of a non-payment inpatient SNF bill, as follows: Type of Bill = 210; Date of Admission = the date the beneficiary entered the SNF; Patient Status = 30, still patient; OC A3, B3, or C3 = the date benefits were exhausted, which may or may not have already occurred and been reported. If benefits are not exhausted, this OC will not appear on the bill; and/or: OC 22 = the date the beneficiary ceased to need skilled care. <<END QUOTE>> "Jamie Morris, RN" <[EMAIL PROTECTED]> wrote: If a tube feeding resident is weaned from the tube, what has to be done to show they are no longer skilled as far as billing is concerned? ex. resident used 100 days of MCR for tube, then later the tube was no longer used for feeding... he went out to the hospital & when he returned he should have had his 60 day break, but what should billing have done to signify he was no longer skilled when the tube was removed? ----- Original Message ----- From: C Hannant To: [EMAIL PROTECTED] Sent: Tuesday, November 25, 2003 9:13 AM Subject: Re: Tubefeeders Yes, that is correct, but that is not the question I was asking.  If they stay in the facility as a full tube feeder, nothing by mouth, I am being told by 2 facilities who went to Medicare Workshops that these people can be re-skilled agin after they meet all the other criteria.  That's what I am wanting in writing.  No one seems to have answered that question yet. Thanks...Cher Callie Larson wrote: You are correct.  The following is the answer posted on the AANAC FAQ list on the website regarading this issue:   A. The period of time the beneficiary was receiving the tube feeding at home does not constitute a skilled level of care for SNF Part A purposes, even if she received skilled home health services under Medicare. Only skilled level of care received in a SNF or a hospital prolong the benefit period. So, if she was at home for 60 days, then she did have the 60-day break in skilled services and would earn a whole new 100-day SNF benefit after a qualifying 3-day hospital stay. This is from the Medicare SNF Manual (Pub 12), Section 240:   [EMAIL PROTECTED] wrote: I always thought that if a person went home on tubefeedings they were at a nonskilled level of care.Anytime the patient goes home the 60 day clock starts. /---------------------------------------------------------- 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 -----------------------------------------------------------/ Caroline Larson, RN, MS, RAC-C MDS/PRI Coordinator Fairport Baptist Homes, Fairport, NY 14450 Do you Yahoo!? Free Pop-Up Blocker - Get it now