Published Jul 25, 2013
I was recently told to to a PPS for 5 days only due to IV antibiotics given in the hospital. When I asked for further confirmation was told it had always been done and that transfusions during hospitalization could be done the same way even though resident did not qualify for any therapy. Does anyone know where to find documentation to support this?
The MDS form itself asks if there was IV therapy in the last 14 days, and whether it was done as a resident or while not a resident (meaning in the hospital).
This is commonly called in the industry as a "Presumption of Coverage". The details of which can be found in the Medicare Benefit Policy Manual Chapter 8 30.1 Administrative Level of Care Presumption p. 18
Do not be confined with the need for therapy alone as the basis for skilled care. A "level of care presumption" only covers the resident from admission to ARD. However, a resident may be at risk for dehydration or altered nutrition due to poor intake post hospitalization or at risk for skin breakdown, etc. Daily documentation to support the needs to avert the effects constitute a skilled level of care. Therefore, if the risk persists, you may be able to extend Medicare coverage after the ARD.
We cannot assume what's in the MDS automatically assigns a resident to a skilled level of care. What was the IV rx or IV med for? An IV rx or IV med received during a surgical procedure is excluded from the Level of Care Presumption. It is not uncommon to use IV AB prior to surgery.
Point being, this is prety basic MDS stuff, right out of the manual, and should even have been determined prior to admit, with the IDT all on board, on the same page. Sounds a bit odd. Maybe this is a very small place that gets so few MED-A patients, they don't get too worked up over RUG scores? I've been to non-profit places that really couldn't care less, since the patients were in a continuum organization, and skilled care was part of their perpetual living package. Or a big place that might be overwhelmed? Or maybe a brand-new MDS nurse? Who knows.
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