I am a MDS consultant in the state of Indiana. CMS is pre-pay reviewing Medicare A claims in one of my buildings. They call it progressive correction action plan. They usually request 1 to 2 claims and I prepare these Medicare A charts and send them in for review. They will either accect, re-rug or deny each claim. I recently sent in a claim in which the resident stayed in our facility after all therapy discontinued. Therapy has set up a restorative program for this resident and we held this resident for 6 days after all therapy had discontinued due to observation of the restorative program. Administar called the facility last Friday and spoke with the DON and stated that restorative nursing is not a skilled need. Now, I'm confused, because I thought it was. Now they want to know where I got the idea that restorative is a MEdicare A skilled needs and they want the answer by 5pm today.
Can anyone tell me where I may find in writing that restorative is a skilled need.
Thank You,
Tracy
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