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If I'm reading this right she has
never been skilled for her tube feeding and she has had a recent 3 day hospital
stay to qualify her and she is receiving more that 51 % of her nutrition via the
peg tube?? If that is correct then I would skill her. Also if she is medicade
you have to use all payment source possible before returning to the state
assistance.
CAR
Could I get a few more responses. So far 2 say yes
and 2 say no. I still don't know what to do. I don't want defraud
Medicare but if this lady is due her days I don't want to deny them. She
was home longer than 60 days and she was in our facility longer than 60 days
when she did not meet criteria for skilled tube feeding.
----- Original Message -----
Sent: Tuesday, April 20, 2004 8:41
PM
Subject: Re: skilling for old peg
tube
This is only accurate if the person has already
used a Medicare SNF benefit period. A beneficiary will not earn a new
benefit period unless s/he has the 60 day break in skilled services.
However, if a beneficiary has never used the benefit before, then there is
no requirement for a "60 day break" prior to using the Med A SNF
days.
If this resident has been in your facility
since 2000 and never used Medicare A, then you can certainly skill her now
for the tube feedings.
HS
----- Original Message -----
Sent: Tuesday, April 20, 2004 4:05
PM
Subject: RE: skilling for old peg
tube
You are right; you can not skill her
because no break in spell of illness. She has been receiving skilled
service for years for the peg tube regardless of never billing under med
A. Unless if she stops the PEG feeds for 60 days or she d/c to a
non-nursing care facility, she will never regenerate her 100 days.
This was a big question for me at the AANAC conference and this
was the conclusion, so I feel pretty confident in this
advice.
monica
I have a situation regarding a resident. We admitted her from
home in 2000 to a non Medicare A bed. At time of admission she had
a PEG tube and eating oral diet. The amount of tube feeding did
not meet skilled criteria. She was supposed to be a respite stay
for 2 weeks but ended up staying. Anyway, she ended up with tube
feeding for 100% nutrition. She has been in facility since 2000
with no hospital stay. She currently was d/c'd to hospital for
pneumonia. My DON thinks that we would be able to skill her for
tube feeding as she never used her Med A days after first
inserted. I am inclined to think no since she has not had a 60
break in spell of illness. What is right? Thanks
Michelle
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