The 60
day break is to break a spell of illness. If this resident was not skilled and
had not had a spell of illness or benefit period ongoing, then just receiving
some skilled services does not put him in a benefit period. A benefit
period is started by a three day hospital stay and ends when the patient has
finished skilled services and has 60 consecutive days of non-skilled
status (either by going home and thus being outpatient even if services were
rendered or by being inpatient in a non-skilled status). The beneficiary is not
thrown back into another benefit period or spell of illness unless they have a
new qualifying hospital stay. Hope this helps, Ck
-----Original Message-----
From: M. Wilson [mailto:[EMAIL PROTECTED]
Sent: Thursday, April 01, 2004 8:03 AM
To: AANAC
Subject: Medicare Part A or BWe have a resident that had a decline in ambulation and was picked up by PT for a month under Medicare part B. He then suffered a CVA w/ hemiplegia. He just came back from the hospital and PT & OT are going to treat him. Admissions and the Admin. want him under Medicare part A, but doesn't the month of therapy right before the stroke mean he didn't have 60 days nonskilled? Thanks for any responses.-----Mike
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