RE: Question Re: letter of predictability

[Ann Schoeny]

What about this scenario: A hip fracture is admitted and has non weight bearing status to that leg. We provide other therapy that is appropriate. The WB status does not change and we have to cut from therapy d/t plateaued in other areas. They go past 30 days since being skilled. Then at day 45 they have ortho appt., and restrictions are lifted. Can you use the letter  at any time during this period, say when the therapy is d/c'd? This has happened to us and we have to pick up under part B. ann m schoeny crnac sem haven nursing and rehab 225 cleveland ave. milford, ohio 45150 (513) 248-1270 -----Original Message----- From: Sam Curran [mailto:[EMAIL PROTECTED] Sent: Tuesday, April 27, 2004 11:20 PM To: [EMAIL PROTECTED] Subject: Re: Question Re: letter of predictability     If I understand the following scenario of a resident admitted to Medicare Part-A but reached a point where additional therapy was to be delayed for 6 to 8 weeks until weight bearing status changed, the resident would not be eligible for coverage under Part-A unless "medical predictability" was documented at the time of the hospital discharge.  If the "medical predictable" delay was documented at the time of discharge from the hospital then the resident could be picked back up on Medicare Part-A when he/she reaches weight bearing status.  Under the 30-day transfer requirements "medical predictability" for Medicare coverage only occurs at the time of hospital discharge.  The "medical predictable" exception to the 30-day transfer requirements exists to insure the skilled nursing care a resident receives is for continuation of care provided in the hospital.  Reference chapter 8 of the Medicare Benefit Policy Manual or Part-3 of the Medicare Intermediary Manual.     I've discovered from experience that if a claim involving "medical predictability" goes to medical review or to an ALJ hearing the preferred type of verification is on a document from the hospital that was issued on the same day the resident was discharged from the hospital.  This is especially important if the resident goes home for a period of time before admission to the skilled nursing facility to receive therapy. S.A. Curran [EMAIL PROTECTED]    ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, April 27, 2004 4:52 PM Subject: Re: Question Re: letter of predictability In a message dated 4/27/2004 10:19:51 AM Eastern Standard Time, [EMAIL PROTECTED] writes: I believe per the Medicare ruling that the letter of predictability has to be signed before admission. I don't have the exact area to find the documentation  for this rule. That is what I have been taught over the years. We have a scenario right now where resident has FX ankle, NWB on skilled therapy for transfers, balance, ADL's, etc. Now at max level but want to be able to pick up again in 6-8 weeks when wt bearing. Does the letter of predictability apply here or does it have to be done prior to admission to the SNF? Thanks for your help