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When I read the second part of
this, regarding the "post-hospital extended care services", it appears to say
within 30 days of the discharge from the hospital, not 30 days from the day of
skilled care ending.... I have a resident who fell, broke her hip, went to
hospital, returned & we gave her MCR A because ther. began to treat. Well,
on day 24 of her stay her ankle swelled, sent for x-ray, determined to be
fractured. She saw an ortho. on day 27 of her stay & became non-weight
bearing. She has nothing else to skill her.... therapy was d/c'd on day
28. From what date do I begin her so-called "30 day window" so
that if she becomes weight bearing she can resume ther. & MCR
A?
----- Original Message -----
Sent: Saturday, January 17, 2004 12:03
PM
Subject: Re: medicare
When a resident is put back on Part A within
the 30-day window, the reason for reinstating the coverage must be related to
the qualifying hospital stay or to care received while in the SNF for care
related to the hospital stay.
This is from the new online Medicare
Benefit Policy Manual
Chapter 8 - Coverage of Extended Care (SNF) Services
Under Hospital Insurance
20.1 - Three-Day Prior
Hospitalization
(Rev. 1, 10-01-03)
A3-3131.1, SNF-212.1
"To be
covered, the extended care services must have been for the treatment of a
condition for which the beneficiary was receiving inpatient hospital services,
including services of an emergency hospital, or a condition, which arose while
in the SNF, or for treatment of a condition for which the beneficiary was
previously hospitalized. In addition, the qualifying hospital stay must have
been medically necessary..."
20.2 - Thirty-Day Transfer
(Rev. 1,
10-01-03)
A3-3131.3, SNF-212.3
20.2.1 - General
(Rev. 1,
10-01-03)
A3-3131.3.A, SNF-212.3.A
"Post-hospital extended care
services represent an extension of care for a condition for which the
individual received inpatient hospital services. Extended care services are
âpost-hospitalâ if initiated within 30 days after discharge from a hospital
stay that included at least three consecutive days of medically necessary
inpatient hospital services."
Rena
Rena R. Shephard, MHA, RN,
FACDONA, RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
Subj: medicare
Date: 1/12/04 10:05:07 PM
Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
I have q uestion here. If sombody can help me with this. We
have a resident that was taken off from Medicare A as of 12/12/03.
This pt. has GT site but we're not using it except for flushing. She had
modified barium swallow last december and it showed Zenker's Diverticulum.
Just last friday, MD ordered to put resident on NPO and start the GT
feeding. Now, we are arguing if we can put resident back to part A since she
is still on 30 day window as of today. I really need response for this for
Our meeting in AM. thanks a lot for ther response.
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