It is an interesting situation! You can continue Medicare coverage for problems that arise while a beneficiary is on Medicare coverage for another problem. If I read this correctly, in this case you are skilling them for problems treated during the hospital and the UTI started after admission to your facility while the person was on Medicare coverage. Given that the UTI is not serious, i.e. treated with oral medication, probably did not even require an MD visit to resident, and UTI symptoms are not causing a decline in resident's functioning I would agree with you that this does not warrant continued coverage. If this were a resident whose past history indicated that they are at high risk of serious complications from UTI's, then you would have a strong case for continuing to cover them a bit longer. Our FI has a nurse on staff who will help with that kind of question; perhaps yours does also. You do not want
to have the claim rejected but on the other hand the beneficiary is entitled to legitimate coverage.
Some additional thoughts:
THE NAC News, from March 6, 2001 has an excellent discussion of what constitues "skilled nursing." The article states, "Observation and assessment is reasonable and necessary when the likelihood of change in a patient's condition requires skilled nursing or skilled rehabilitation personnel to identify and evaluate the patient's need for possible modification of treatment or inititaion of additional medical procedures. It is needed until the patient's treatment regimen is essentially stabilized. ...Factors intermediaries consider in evaluating the need for skilled observation and assessment include:
- Condition of the patient at discharge from acute facility;
- Consideration of factors that may indicate medical instability, e.g., changes to medications or unstable laboratory values; and
- Multiple medical problems that are likely to interact to create complications or actue episodes."
Look at your resident with those factors in mind to determine whether continued coverage is appropriate. The key in this is not the diagnoses per se but rather the resident's needs and level of stability given his whole health situation.
[EMAIL PROTECTED] wrote:
I have already skilled this resident for the 5 day PPS for IV's in the hospital and skilled observation. They got a UTI after coming back from the hospital and the new supervisor they just hired (EX- RNAC) thinks I should continue to skill this resident for a UTI and I told her no. He is stable, jus being treated on oral ABT. I have to stand my ground or she will be telling me how to do my job forever more.
Caroline Larson, RN, MS, RAC-C
MDS/PRI Coordinator
Fairport Baptist Homes, Fairport, NY 14450
Do you Yahoo!?
Yahoo! SiteBuilder - Free web site building tool. Try it!
