[ezspirit]

i was told if after a 3 day qualifying hospital stay and a 60 or 90 day spell of wellness then we can restart a previous resident who exhausted a while ago. Only I'm getting different descriptions of what qualifies as a "spell of wellness." Can someone please explain?! I'm not sure he should of started back on medicare.

[Nascar nurse]

The terminology I have always been taught, requires a 60 day break in the spell of illness, ie: receiving no skilled nursing care (same kinda care skilled nrsg care that would "normally" be covered under medicare A), skilled therapy, discharges back to hospital for acute illness, etc.

Example: Resident admitted with acute CVA, has stage IV pressure ulcer w/ daily skilled dressing changes. Res. receiving PT/OT/ST. Day 100 comes along and medicare A is done, but resident continues to require these same skilled services until (lets say) day 152. Day 152 wound is healed, therapies all done, etc. From this day forward, the resident would need 60days of "wellness" to be requalified for medicare.

[ezspirit]

thanks. About a month after the resident exhausted, he developed an infected lesion which required daily tx's and infection precautions. if this applies as skilled and a break in the spell of wellness then he shouldn't be restarted. right?

[Talino]

Originally Posted by ezspirit

thanks. About a month after the resident exhausted, he developed an infected lesion which required daily tx's and infection precautions. if this applies as skilled and a break in the spell of wellness then he shouldn't be restarted. right?

That is correct. You will need to start counting again the day after the last skilled day until 60 consecutive days (skill-free) is achieved. Once that criterion is met, even if resident resumes skilled services again on day 61, he is already entitled to a new benefit period of 100 days after a 3-day hosp stay.

This is a consumer's guide but a concise reference for professionals...
http://www.medicare.gov/Publications/Pubs/pdf/snf.pdf