Re: Tubefeeders

[carol maher]

I think that the FI was concerned   because facilities were not reporting when tube feedings ended  or when wounds were healed, so the residents were not getting the 60 day break in skilled services reset.  Also, I think that the letter in its entirety was to tell facilities to continue the resident as skilled until the skilled services end and to then notify the FI of the end of skilled services--which should not usually be at day 100.  So, I think that is what we have been saying.  Skilled services do not end just because the 100 days of Medicare coverage exhausts, but when/if the skilled services do end the facility needs to send in a bill which shows the end of the skilled services.


-----Original Message-----
From: Corey <[EMAIL PROTECTED]>
Sent: Nov 26, 2003 1:32 PM
To: [EMAIL PROTECTED]
Subject: Re: Tubefeeders

This may be a little confusing, but try to follow me here:

 

I spent a good part of two hours on the phone w/ United Goverment Services, a fiscal intermediary, whom I got to after being referred by the Medicare Part A assistant.  (Med A indicated that they had no information about a change in tube feeder Part A benefit periods in their newletters, memos or program letters.)  UGS went thru every Medicare Memo, and every Program Update, and every Hot Topic from June 2003 thru Sept. 2003, and I went to the page, and looked as well.  There has been no change that is listed in the Medicare Memos, nor the Provider Program memos.  However, there was the portion listed on UGS's site that says:  (DATE: 6/9/03)

 

>>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. <<   I wonder if these folks received this, and have misinterpreted it.  If you follow these directions (Theresa, HELP!) it would appear that the CWF will see these folks as having a new benefit period after a new 3 day hospital stay, even though they did not stop receiving skilled care, they merely "exhausted" their benefit.  If they fill out OC 22 with the date that benefits exhaust, it appears that the skilled care was no longer needed, and the CWF would then show days available after a new 3 day hospital stay.    In any event, Medicare knows nothing about this, but that isn't saying much.  Half the time, the government can't understand itself due to size and separation of departments.  Corey

----- Original Message -----

From: C Hannant

To: [EMAIL PROTECTED]

Sent: Wednesday, November 26, 2003 2:18 PM

Subject: Re: Tubefeeders

In agreement w/Denise, understand that I know everything everyone is telling me.  That is not the question.  There was supposed to have been a change to Tube Feeders not being skilled that was published in one of the monthly newsletters sometime around August.  Actually in a CMS Newsletter.  Now we know that they have been making changes and not getting the word out well, ie August changes that were only found by one of our members, also the new ABN form that's to start either this fall or next spring (who knows for sure).  That's all I'm asking for is the source document.

thanks...cher

[EMAIL PROTECTED] wrote:

Just a question, so please don't bite my head off >GRIN< As if this bunch would.

Thank you in advance for your replies?

 

If you have a resident on Medicare Part A with a Stage IV decub that you can't seem to heal and they used their entire 100 day benefit period. Would you put them back on Medicare Part A if after 70 days from being discharged from Medicare Part A the doctor put the resident in the hospital to repair the same Stage IV decub with a flap and kept them in the hospital for at least 3 midnight's?

Would this be the same as the resident being fed via the tube?

 

ask Sherry Kennedy to show you where the SNF manual was changed, regarding ending a benefit period. 

I agree with Holly on this one. In ALL my training from the FI, once a resident reaches a skilled level and stays at a skilled level exhausting all Part A benefits, there are no more Part A days. Part B may be different, but Not Part A.

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