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If Medicare has never been sent a
"discharge, no pay bill" from the facility for her tube, she would qualify
for her days.
I would skill her. She has never
used her Med A benefit and sounds like she would qualify for Med A
coverage now that she has had a 3-day qualifying hospital stay.
Ron
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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