The issue is whether or not it is "reasonable and necessary and ...as a practical matter," that these services be performed in a SNF. If the patient or wife is unwilling, or unable, to continue care at home, then it would be "reasonable and necessary, as a practical matter..." for the services to continue in the SNF. A hospital-based SNF falls under the same regulations as a free-standing SNF--the person can remain if he/she requires daily skilled services which, as a practical matter, can only be delivered in an inpatient setting and which are reasonable and necessary.
I agree that the patient COULD stay in the SNF. So you are right "on base"! Eileen On Thu, 1 Apr 2004 13:51:51 -0600 "Richardson, Christine" <[EMAIL PROTECTED]> writes: > I believe he is still skillable and if the family wants to push the > issue > they can do demand billing. > With the demand billing the rest stays on Medicare to finish his > 100 days, > while the mds continues it scheldule.The facility send the mds and > supportive documentation to Medicare. They review it. > > If Medicare denies the bill the res is responsible to pay the bill, > but if > the Medicare department agree with the res that he is still > skillable this > could be a problem for the facility. > > -----Original Message----- > From: karen white [mailto:[EMAIL PROTECTED] > Sent: Thursday, April 01, 2004 1:23 PM > To: [EMAIL PROTECTED] > Subject: DISCHARGE FROM FACILITY ?? > Importance: High > > > I have a question for the group. Hopefully I did not make it too > confusing.... > Resident is here coming up on 60 days.(we are scu in hospital this > length of > stay highly unusual) > For the 60 days he has received IV ABT,(MRSA) and bid dressing > changes to a > stasis ulcer on ankle. > Here is the problem. > The director and case manager are working on discharge for this > resident. He > would go home with his wife.He is alert and oriented and independent > in all > adls.He does have severe COPD and O2 dependent. > He and wife are very reluctant to leave they want to stay here and > continue > with IV abt and bid dressing changes.They know they have 100 days. I > have > discussed with them the pro's and con's of using all 100 days. > Director and case manager have given them a number of options, and > all > include cont his IV abt and dsg changes. > I am uncomfortable with this , and have had my say because he is > still > skilled in my eyes. Are they able to force the issue and insist he > leave as > he can get the same level of care at home going to outpatient care > for the > IV abt and dsg change. I have told my director that I feel they > cannot force > him to leave as long as he remains skilled in medicare's eyes. Even > if he > can get the care as outpatient. > They tell me we send people home all the time with IV meds, dsgs > etc. And I > agree but because that resident wants to go home.... This resident > does not > want to leave. Am I off base on this one. Please clarify this for > me . > THANKS KAREN > > > > > ____________________________________________________________ > Find what you are looking for with the Lycos Yellow Pages > http://r.lycos.com/r/yp_emailfooter/http://yellowpages.lycos.com/default. asp > ?SRC=lycos10 > /---------------------------------------------------------- > The Case Mix Discussion Group is a free service of the > American Association of Nurse Assessment Coordinators > "Committed to the Assessment Professional" > Be sure to visit the AANAC website. Accurate answers to your > questions posted to NAC News and FAQs. > For more info visit us at http://www.aanac.org > -----------------------------------------------------------/ > > NOTE: This e-mail message may contain information that is > privileged, confidential, > and exempt from disclosure. It is intended for use only by the > person to whom it is > addressed. If you have received this message in error, please do not > forward or use > this information in any way. Delete it immediately and contact the > sender as soon > as possible by the reply option or by telephone at the telephone > number listed (if > available). In the event you cannot fulfill your obligation or > there has been any > improper release of this information, please contact the Privacy > Officer at Carondelet > Health at (816) 943-4611. > > > > > /---------------------------------------------------------- > The Case Mix Discussion Group is a free service of the > American Association of Nurse Assessment Coordinators > "Committed to the Assessment Professional" > Be sure to visit the AANAC website. Accurate answers to your > questions posted to NAC News and FAQs. > For more info visit us at http://www.aanac.org > -----------------------------------------------------------/ > > To admit you were wrong is to declare you are wiser now than before. --Unknown /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
