Aren't these presenters NUTS!!! And they wonder why facilities get
confused. Maybe it was the presenter assigned by the Intermediaries
that are saying things to confuse the two people who told me this. If
I ever get anything in writing from them, I will share with everyone.
I appreciate everyone's searching and responding. I am going back to
bed as I am nursing a cold. Thanks again...cher
Cindy Gilmer wrote:
I forgot to give his other bullet on the same slide that
supports the possibility of a break:
"No break in a spell of illness if the patient continues to meet
the skilled care definition and resides in a certified bed"
(emphasis mine)
When questioned during the seminar, he couldn't give us any
reference, just said "that is what we are saying".
Date:
Wed, 26 Nov 2003 18:16:28 -0800 (PST)
From: Cindy Gilmer
Subject: Re: Tubefeeders
To: [EMAIL PROTECTED]
Cheryl,
Getting back to your original question:
I attended a Medicare Billing seminar by Adminastar Federal
(Intermediary for Indiana and others) on 08/12/2003. During a slide
presentation, of which I have a copy, the gentlement stated that "
Break in spell occurs if: 1. Facility-free for 60 days or in
noncertified bed (billed as non-resident) 2. Non-skilled level of care
for 60 days.". Most of the room went WHAT???? This statement
obviously has HUGE implications for those Nursing Facilities that
maintain a distinct part as Medicare certified and do not have all
their beds dually certified. I did make a request for more official
documentation and clarification but, of course, have never received
anything.
According to the above, anyone who was a tube feed and was
moved out of the distinct part into a non certified bed would start a
new benefit period after 60 days in that noncertified bed and could
then again, presumably, be skilled for another 100 days for the tube or
any other diagnosis following another qualifying hospital stay.
Cindy Gilmer
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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