In order for the resident to be considered at a skilled level of care for Medicare , he/she must meet the following criteria:
K6a is 51% or more calories OR
K6a is 26% to 50% calories and K6b is 501cc or more fluid per day fluid enteral intake in the last 7 days
So, flushes only would not meet that definition and the resident could be removed from skilled care per Medicare. Medicaid skilled is different, and should not affect the rules for the break in skilled services for Medicare.
-----Original Message-----
From: Tracy Howard <[EMAIL PROTECTED]>
Sent: Mar 8, 2004 10:44 AM
To: [EMAIL PROTECTED]
Subject: Medicaid skilled vs. Medicare
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-----Original Message-----
From: Tracy Howard <[EMAIL PROTECTED]>
Sent: Mar 8, 2004 10:44 AM
To: [EMAIL PROTECTED]
Subject: Medicaid skilled vs. Medicare
I am Kentucky and have always been under the impression if a tube feeder stops receiving tube feedings and are getting flushes only after they have used their 100 days of Medicare, then a demand bill can be sent to Medicare to start the 60 day period of unskilled care and could potentially use their Medicare days again.
We have a new admissions coordinator who is telling me that in Kentucky, a g-tube is considered skilled Medicaid even without feedings and if they are skilled Medicaid, then the resident can never regenerate those Medicare days.
Does anyone have any ideas or references they could share on this one?
Thanks, Tracy Howard, RN
