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Per page 6-15 of the RAI manual, the skilling criteria for tube feeding is
either : provides 51% or more of the daily calories or provides 26-50% of daily
calories and is at least 501 cc per day of entereal fluid intake. If the
resident begins eating and the tube feeding level falls below these guidelines,
the resident would not longer be considered skilled. The facility would
need to send in a bill to show the end of skilled services for that resident to
start the 60 day period of wellness.
The presumption of coverage only applies if the resident will be in the top
26 RUGs categories on the first PPS assessment. The presumption of
coverage only applies through the ARD of the 5 day assessment. See the
final PPS rule for details in the Federal Register.
----- Original Message -----
Sent: Thursday, February 26, 2004 8:37
AM
Subject: billing g-tubes/psych stays on
Medicare
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I am trying to find out some
information regarding g-tubes and Medicare. I was taught that if you have
skilled a resident 100 days for a g-tube, but later on they start eating and
are no longer receiving feedings through the tube, (only flushes) that because
they fall below that skilled criteria of receiving 26% or more feedings
through the tube, that they qualify to regenerate their 100 days on Medicare.
Does anyone know the
guidelines on this?
Also I have a question about
skilling those that come back from a 3 day psych stay. If they are going to fall below the
upper 26 RUGS can they be skilled on Medicare even through day 8? The AANAC course I took stated
that the presumption of coverage through day 8 is only for those who will have
RUGS in the upper 26. Does anyone
have any info on this as
well?
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