Private Insurance

[Libby Cawthorn]

I eval'd a patient for our unit that has private insurance. She did not meet the criteria (Medicare guidelines) for skilled care but the insurance company wanted her moved and they would pay a negotiated rate. I've never had this particular problem, usually the patients meet skilled criteria, so I am not sure what is correct. I know that a MDS must be filled out on all residents day 14 regardless of payor source, but meeting the skilled criteria bothers me. We are a Medicare certified unit  only. Rena, do you have any thoughts on this.                   Libby Cawthorn, RN Director/MDS Coordinator SNF TJ Samson Community Hospital 1301 N. Race Street Glasgow, Ky. 42141-3483 Fax# 270-651-4786 Phone# 270-651-4783