Medicare Cut Letters

[sls73]

I hae two scenerios coming up that I was wondering what others did:

1. If a resident is discharged from a skilled level of care to a personal care facility or independent living- Do you give a 2 day notice. Sometimes it is in the residents best interest to not wait- say the family is going to be here for the day and they want to help with the process, what do you do? Can you give the notice explaining that it is not a 2 day notice because its in the best welfare of the resident?

2. If a resident is being discharged from a skilled level of care to home with family but still meets the skilled need what would you do? We have a situation where a resident still meets the skilled level of care- is going to be getting therapies at home, but the family is planning on letting the resident move in with them, so they can help with the care. Would you still use a medicare 2 day notice form although knowing if they stayed in the facility you would probably be still keeping them on medicare- or would you explain that on the letter and that the family still insists on taking them home. She has improved since her baseline admission, but is not going home independently as she was living before.

Any suggestions or comments appreciated. Thanks

[edhcinc]

Hi.

Isn't it amazing how nurses are now responsible for understanding and implementing all aspects of ANYTHING/EVERYTHING related (vaguely or not) to the MDS or PPS?

As to the generic notice...

The Generic Notice is required to be given at least 48 hours in advance if services that the person may elect to receive no longer meet MC criteria--the person has the option to continue to receive the services and self-pay.

In #1 you don't need to say that you are giving less than 48 hours because the person could still be eligible if the resident/family had not requested discharge before the 48 hour period had ended.

In #2--I would not give a Notice because, as you stated, the person was still eligible for skilled services and the facility has no plans to discontinue--but the person will not be in the facility to receive them. Notes from rehab and social services should explain the circumstances.

Good luck! (see FFS Revised ABN Beneficiary Notices Initiative (BNI) for a link to the abn manual)

[pkw0002]

According to Medicare guidelines, you should issue the generic notice in both cases. Anytime a Resident discharges home with days remaining, (including PC or ALF), the notice should be issued 48 hours in advance. Assuming the discharge was planned at least 48 hours in advance. If the Resident or family decided to leave without 48 hour notice, simply note that on the Generic Notice, "Patient discharged per their preference."