Skilling For Tube Feeding

I can't point you to a specific reg, but i would... skill the resident for a new peg tube up until the point that they are clinically stable, ie: weights are stable, it's determined they are tolerating feeding w/o adverse effects, no signs of aspiration, etc. Once they are clinically stable, which is often less than the 100 days, than take them off medicare.

If you end up running thru the 100 days, then you end up in a benefit exhaust situation (which lets medicare know that the resident is still unstable and IF you have more skilled days you would have continued to use more). Example, the resident is "clinically stable" after day 150, then the billing department would do whatever it is they do to let medicare know the benefit exhaust situation is resolved. 60 days from that time frame the resident should have a new 100 days available.

If the resident falls below this critera he/she will generate a new 100 days.( after 60 day break)

Enteral feeding that comprises at least 26 percent of daily calorie requirements and provides at least 501 milliliters of fluid per day;


If resident does not fall below those guidelines then they remain at a skilled level of care and DO NOT regenrerate a new 100 days,regardless of new dx,3 day hosp stay etc..

Again, sorry, I can't direct to the specific reg, I am just going as directed by my coorporation management direction, but...

I understand this was the "old" way of dictating medicare coverage, but some residents will FOREVER require 26+% of daily calorie requirements and that is why the directive was changed that we should only cover for an unstable condition. Once they are clinically stable, they are off medicare. This same thinking would apply to other potentially "chronic conditions" such as ESRD w/ dialysis, etc. Once they are medically stable it all becomes just maintainance care of which medicare never covers.

Better for the resident that way,only using when unstable. Some companies require you to use up all 100 days.

It is my understanding that they can be skilled again (after the 60 day period) but they can never be skilled for the tube feeding again. It has to be something different.

To be eligible for a new benefit period the person has to not have received any skilled services within a 60 day period. It falls under the spell of illness regulations.
Because the resident with the feeding tube will always receive care at a skilled level (presumably) there will not be a break in the spell of illness which would qualify them for a new benefit. This is regardless of the new illness or injury. Resident can fall and have a hip fracture and receive therapy but have a feeding tube prior which was billed under Medicare Part A at time of initial insertion and either some or all of the days were used because the resident continued to receive the feeding tube and it is a skillable service, there was no break in the spell of illness therefore no more benefit.

In our facility, as long as someone receives more then 26% of their calories from tube feeding, even if they're stable, they remain on Medicare A, and after all 100 days are used, they remain skilled. The only way they can become "unskilled" is if the tube feeding is less then 26% of calories or discontinued. If that occurs, then they need a 60 day period with no skilled service before they would be eligible for Medicare A benefits after a three day hospital stay again. As far as I know that's a federal regulation. For our pts who have secondary insurance that follow Medicare A regs, we have to do an assessment every 30 days to show that the pt is still skilled, and they meet the criteria every time when they have a tube feeding.

Hope this helps!!