The UB 92 may generate a new skilled period, but this
does not mean that they are entitled. You have to follow the guidelines or a
focused review may eliminate a lot of funding. I would continue to follow the
SNF manual.
Brenda W. Chance, RN, RAC-C
MDS Coordinator
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-----Original
Message-----
From: Holly Sox,
RN, RAC-C
[mailto:[EMAIL PROTECTED]
Sent: Wednesday, November 26, 2003
6:44 AM
To: [EMAIL PROTECTED]
Subject: Re: Tubefeeders
Ahh, well then, ask
Sherry Kennedy to show you where the SNF manual was changed, regarding ending a
benefit period. I don't know if you saw my rant a few weeks ago about
consultants, but that's one of the things that keeps me from becoming one.
There are too many things that I still don't know, and so many consultants out
there will tell you what they think, rather than having factual information.
Trouble is, you
can't always tell what type you are getting until you have already paid the
fee.
----- Original
Message -----
Sent: Tuesday,
November 25, 2003 7:54 PM
I understand that and
have always taught that. However, Sherry Kennedy in TX and the BC/BS FL
intermediary training this spring and fall said that this has changed. I
am just looking for it in writing.
Thanks...cher
Holly Sox, RN, RAC-C wrote:
No, No, No!
If the resident remains at Medicare skilled level of care, receiving skilled
services, then the benefit period does not end. Ever.
----- 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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