I will disagree with Christine's response: Per the Code of Federal Regulations: "Rehabilitation nursing procedures, including the related teaching and adaptive aspects of nursing, that are part of active treatment and require the presence of skilled nursing personnel; e.g., the institution and supervision of bowel and bladder training programs; � Initial phases of a regimen involving administration of medical"
Also from the Benefits Policy Manual Chapter 8- Section 30.6 "EXAMPLE A patient who normally requires skilled rehabilitation services on a daily basis may exhibit extreme fatigue, which results in suspending therapy sessions for a day or two. Coverage may continue for these days since discharge in such a case would not be practical. In instances when a patient requires a skilled restorative nursing program to positively impact his functional well-being, the expectation is that the program be rendered at least six days a week. (Note that when a patient�s skilled status is based on a restorative program, medical evidence must exist to justify the services. In most instances, it is expected that duration of a skilled restorative program last only a couple of weeks.)." Per the above 2 citations- I do believe that nursing rehab can be skilled if correctly documented. Theresa Lang Specialized Medical Services, Inc. Milwaukee WI -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Christine Kroll Sent: Monday, January 19, 2004 2:07 PM To: '[EMAIL PROTECTED]' Subject: RE: Rena: Restorative as Med A Skilled Need? Restorative nursing programs are not a skilled need by themselves. Nursing could have skilled for observation and management or careplanning if documenting the daily skilled services they are providing regarding assessments and nursing intervention and restorative nursing can be part of it. Restorative nursing is part of the skilling services in Rehab Low when in combination with therapy services as legislated; however, by itself restorative nursing would not be a skilled service. -----Original Message----- From: Tracy Adkins [mailto:[EMAIL PROTECTED] Sent: Monday, January 19, 2004 1:19 PM To: [EMAIL PROTECTED] Subject: Rena: Restorative as Med A Skilled Need? Rena, 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 _________________________________________________________________ Let the new MSN Premium Internet Software make the most of your high-speed experience. http://join.msn.com/?pgmarket=en-us&page=byoa/prem&ST=1 /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
