Yes, I am aware of all these things. It's just
that this is new information and I want to confirm it. Thanks
anyway...cher
Corey wrote:
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 -----
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:
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
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