This is from the Medicare Benefit Policy Manual
Chapter 8 - Coverage of Extended Care (SNF) Services Under Hospital Insurance
<<QUOTE
Under SNF PPS, beneficiaries who are admitted (or readmitted) directly to an SNF after a qualifying hospital stay are considered to meet the level of care requirements of 42 CFR 409.31 up to and including the assessment reference date for the 5-day assessment prescribed in 42 CFR 413.343(b), when assigned to one of the Resource Utilization Groups (RUGs) that is designated (in the annual publication of Federal prospective payment rates described in 42 CFR 413.345) as representing the required level of care. For purposes of this presumption, the assessment reference date is defined in accordance with 42 CFR 413.34(b), and must occur no later than the eighth day of posthospital SNF care. The coverage that arises from this presumption remains in effect for as long thereafter as it continues to be supported by the facts of the beneficiary's condition and SNF care needs. However, this administrative presumption does not apply to any of the subsequent assessments.
A beneficiary who groups into other than one of the Resource Utilization Groups designated as representing the required level of care on the 5-day assessment prescribed in 42 CFR 413.343(b) is not automatically classified as meeting or not meeting the SNF level of care definition. Instead, the beneficiary must receive an individual level of care determination using existing administrative criteria and procedures.
In general, CMS presumes that beneficiaries admitted to an SNF immediately after a hospital stay require a skilled level of care. Therefore, CMS has developed the presumption of coverage policy outlined here in this subsection. This presumption of coverage policy applies to the Medicare stay from the date of admission to the ARD of the 5-day MDS.
When a beneficiary is assigned correctly into one of the top 26 RUG categories, it is believed that care provided to the beneficiary meets the skilled level of care definition. Nonetheless, there must be supportive documentation in the clinical record addressing the needs of the beneficiary and the skilled services being rendered to the beneficiary by the facility staff.
When a beneficiary is assigned into one of the lower 18 categories, he or she is not automatically classified as meeting or not meeting the definition of skilled services. An individual level of care determination using the administrative criteria outlined below should occur. These criteria are also used in situations where an MDS is not available (e.g., demand bills, bills submitted at the default rate, etc.)
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Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Re: Skill or not
Date: 1/16/04 5:01:50 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
I'm at home and just going from memory but I think that when you code an IV in section K on a 5 day assessment (assuming they had the IV within the 7 day look back period) it skills a resident for day 1-14.
Janice
In a message dated 1/16/2004 7:44:17 PM Eastern Standard Time, [EMAIL PROTECTED] writes:
"You can't skill on an IV alone for more than the first 14 days."
Janice Martin, RN
Please explain the regulation you are referring to.
Thank you!
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Re: Skill or not
Date: 1/16/04 4:31:00 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
In a message dated 1/16/2004 11:25:56 AM Eastern Standard Time, [EMAIL PROTECTED] writes:
You can't skill on an IV alone for more than the first 14 days.
Janice Martin, RN
MDS Coordinator
The resident was not in our facility on 01/11/04 therefore I cannot do a OMRA since therapy was never started in our facility. She was admitted on 01/13/04 and was no therapy for 3 weeks. My question being can I skill her for those 3 weeks based on her getting this IV on 01/11/04?
Lisa
In a message dated 1/16/2004 6:48:02 AM Mountain Standard Time, [EMAIL PROTECTED] writes:
If the resident just had an IV on 1-11,I would do an omra and keep on med A alittle while.Would look at it weekly and would do a sig change when rehab can come back.I feel a sig change is necessary when weightbearing increases as there usually is an improvement in amb and toileting.
