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For
any service to be covered my Medicare- it must be physician
ordered.
source Benefit
Policy Manual- Chapter 8 (Extended Care Services)- Section 30- cut and pasted
below
Therefore to the
confusion- to score on the MDS physician orders are not needed- but to qualify
as a Medicare skilled service- physician orders are needed
State Medicaid
reimbursement requirements vary from state to state on this issue.
Theresa
Lang
Specialized Medical
Services, Inc.
Milwaukee
WI
Care in a SNF is covered if all of the following four factors are
met:
- • The patient requires skilled nursing services or skilled rehabilitation
services, i.e., services that must be performed by or under the supervision of
professional or technical personnel (see §§30.2 - 30.4); are ordered by
a physician and the services are rendered for a condition for which the
patient received inpatient hospital services or for a condition that arose
while receiving care in a SNF for a condition for which he received inpatient
hospital services
- • The patient requires these skilled services on a daily basis (see
§30.6); and
- • As a practical matter, considering economy and efficiency, the daily
skilled services can be provided only on an inpatient basis in a SNF. (See
§30.7.)
- • The services must be reasonable and necessary for the treatment of a
patient’s illness or injury, i.e., be consistent with the nature and severity
of the individual’s illness or injury, the individual’s particular medical
needs, and accepted standards of medical practice. The services must also be
reasonable in terms of duration and quantity.
If any one of these four factors is not met, a stay in a SNF, even though it
might include the delivery of some skilled services, is not covered. For
example, payment for a SNF level of care could not be made if a patient needs an
intermittent rather than daily skilled service.
My friend went to a meeting and the concultant told
the group thta in order for restorative tocount for the rehab low catagory,
there must be a physician's order for rehab nursing. has anyoone heard
this and where in the rules does it sat this?
Thanks so much
Joan
M
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