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Well, as far as linking this
fracture to the hip fracture... it is the same leg... but the ankle fracture
evidenced approximately 24 days after the hip fracture. When the hip was
x-rayed at the time of the fall,
the ankle was not. She has Osteoporosis that, I am sure, attritibuted to
the hip fracture & ankle fracture. Staff reports to me that they do
not believe the ankle & hip were fractured at the same time. As a matter of
fact, I just found out, as I am composing this e-mail, that the
resident's roommates daughter observed another resident in the room in a
merry-walker and saw her get "tangled-up" with this resident's foot!! Now
doesn't that open a whole new can of worms! But, back to original issue, would
you relate the fractures? Plus she never finished all the therapy for her
hip fracture, so when she is weight bearing again she will need to continue that
therapy....
Thank-You for taking the
time to answer this!
----- Original Message -----
Sent: Saturday, January 17, 2004 2:18
PM
Subject: Re: medicare - One More
Regulation
Sorry - this one got dropped in the cut and
paste:
20.2.3 - Readmission to a SNF
(Rev. 1,
10-01-03)
A3-3131.3.C, SNF-212.3.C
"If an individual who is receiving
covered post-hospital extended care, leaves a SNF and is readmitted to the
same or any other participating SNF for further covered care within 30 days of
the last covered skilled day, the 30-day transfer requirement is considered to
be met. Thus, the period of extended care services may be interrupted briefly
and then resumed, if necessary, without hospitalization preceding the
readmission to a SNF. (See ÂÂ20.2.2 and 20.2.2.3 above for situations where a
period of more than 30 days between SNF discharge and readmission, or more
than 30 days of noncovered care in a SNF, is followed by later covered
care.)"
Remember that the definition of "leaving a SNF" doesn't mean
that the beneficiary has to physically leave the facility. The
definition relates to whether or not the resident is receiving a skilled level
of care under Medicare's definition.
My question for [EMAIL PROTECTED] is: Can you
relate the new ankle fracture back to care the resident received during the
3-day qualifying stay or to a condition that arose while in the SNF on Part A
coverage related to the 3-day qualifying stay? If so, then you can cover
her if it is within 30 days of her last covered skilled
day.
Rena
Subj: Re: medicare
Date: 1/17/04 10:36:35 AM
Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
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 -----
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
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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