RENEWING BENEFIT PERIOD

[Delores234]

I cannot believe it, however, I did receive this reply from CMS.  I thought it might be useful to the billers and RNAC's on the list

Very interested in Rena and Theresa's comments

Delores



Subj: Re: Medical Devices and Prosthetics�
Date: 1/2/2004 5:52:59 AM Pacific Standard Time
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet (Details)



FAH-11



Dear Ms. Galia:

Thank you for your email inquiry concerning a Medicare billing for a
resident in a certified SNF.

A UB-92 form should be submitted even if a Medicare beneficiary has
exhausted their Medicare Part A benefits.

When documenting the final UB-92 form, code 22 should be used
indicating that benefits have been exhausted and the date of the last
covered day on the UB-92 form or the electronic equivalent.�

The CWF will not show a new benefit period for this resident 60 days
after the benefit period has been exhausted.

A resident will never have another benefit period as long as they
continue to receive skilled care after the benefits are exhausted and
the resident remains in a certified bed without a break in skilled care.


You may wish to reference Chapter V of the Skilled Nursing Facility
Manual for guidance for proper billing procedures at
www.cms.hhs.gov/manuals/.

Should you require additional assistance regarding this same matter,
please include the following reference number:� 153990.



>>> CAGInquiries 12/01/03 04:27PM >>>
Dear Ms. Galias:

Thank you for your email inquiry.� We are forwarding your inquiry to
our Center for Medicare Management.� Currently they have a backlog of
inquiries, but will respond to you as quickly as they can.

>>> <[EMAIL PROTECTED]> 11/29/03 05:32PM >>>
FirstName:� DELORES
LastName:� GALIAS
Email-address:[EMAIL PROTECTED]
Question: have spent hours searching the UGS and CMS website and
cannot come up with the documentation I need.

Example:
Resident is admitted to a certified bed in a SNF.

Had at least a 3-day qualifying acute care hospital stay
within 30 days of admission to the SNF.

Resident needed and SNF provided Total Enteral Nutrition
via Gastrostomy tube and met the Skilled guidelines of
amount of calories and fluid volume.� [Feeding was
totally via g-tube, no oral]

Medicare Part A Benefits are exhausted, resident
continues to receive tube feeding at same level as when
receiving Part A benefits and remains in a certified
bed.� Payment for the tube feeding is now billed to
Medicare Part B..

Questions:
1. Does the biller need to send in a UB when benefits
are exhausted?
2. How does the biller code the final UB, "no longer
skilled care" or
�� "continues to receive skilled care?"� And What codes
are used for
� �� each situation.
3. Will the CWF show a new benefit period for this
resident 60 days
� � after benefits have been exhausted?
4. Where can I find these instructions in print either
by UGS or CMS?

It is my understanding that the resident� will never
have another benefit period as long as she/he continues
to receive skilled care after benefits are exhausted AND
the resident remains in a certified bed with no break in
skilled care and never leaving a certified bed.

Thank you in advance for your reply to this request.

Delores L. Galias, RN, RHIT
Address1:1981 RANGEVIEW DRIVE
Address2:
City:GLENDALE
State:CA
Zip:91201
Country:USA





Delores L. Galias, RN, RHIT

STATEMENT OF CONFIDENTIALITY:
The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the intended recipient, please notify D. Galias, RN, RHIT immediately at [EMAIL PROTECTED] and destroy all copies of this message and any attachments.  Thank you for your cooperation