Thank
you, Rena. I appreciate your response. Got it.
Learning...in Texas.
Julie
-----Original Message-----If the resident continued to meet the criteria for skilled coverage in the nursing home (the enteral feeding accounts for at least 51% of daily calories, OR the enteral feeding accounts for 26% of daily calories AND 501 cc daily intake) even though Medicare wasn't paying the bill (because benefits were exhausted), then he did not have a 60-day break in skilled level of care and would not earn a new benefit period after a 3-day hospital stay.
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Tuesday, April 27, 2004 3:39 PM
To: [EMAIL PROTECTED]
Subject: Re: Spell of illness-Rena, please respond.
Even though you can't cover the resident in your scenario on readmission to the SNF if he continued at a skilled level of care even though Medicaid was paying the bill, I want to address the underlying question of whether a resident can be covered for an existing tube feeding even though the hospitalization did not pertain directly to the tube feeding. If he otherwise meets the criteria for coverage under Part A in terms of 3-days stay, benefit days available, etc., then he can be covered for the tube feeding if it meets the level of care criteria indicated above. The requirement is that the SNF stay must be needed for a condition which was treated during the qualifying 3-day stay (for example, a resident who received treatment related to the tube feeding during the 3-day qualifying stay even though the reason for the hospitalization was something else) or which arose while in the facility for treatment of a condition which previously was treated in the hospital.
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Spell of illness-Rena, please respond.
Date: 4/27/2004 8:53:42 AM Pacific Daylight Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
If a patient is admitted for skilled services for feeding tube and exhausts
all Medicare days...goes on Medicaid...next year goes to hospital...comes
out with continued feeding tube....can she be skilled? Does the
hospitalization have to pertain to the feeding tube?
Julie Thomas, RN BSN
Quality/Clinical Coordinator
KB Enterprises
254-445-2517 ext.16
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