Cheryl,
There is no new information.� Whoever told you this
must have been mistaken.�
Brenda W. Chance, RN, RAC-C
MDS Coordinator
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-----Original
Message-----
From: C Hannant
[mailto:[EMAIL PROTECTED]
Sent: Tuesday, November 25, 2003
8:00 PM
To: [EMAIL PROTECTED]
Subject: Re: Tubefeeders
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
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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