3 day observation vs. 3 day discharge planning

[MDSsue]

Hi Every one please help. I have been in mds for 10 months. And I have been coordinator for 5 months. I have very little formal training, but have been diligently self-educating. I am constantly learning something new. I was wondering if anyone could tell me if a 3 day observation period is still allowed with medicare. And is it considered the same as 3 day discharge planning?

[Talino]

When therapy is discontinued it is assumed that resident reached maximum potential. Observation by nursing staff with therapy referral prn to ensure that resident maintains that physical function is not, by itself, a skilled service.

In a case of a medical condition, a daily skilled nursing observation "can" extend up to the day of discharge.

Example: A patient is treated for CHF exac. in hospital. He returns to SNF for further management of an erratic p.o. intake. The condition stabilizes on day 8 and discharge plan is sched. in 3 days. If you continue to provide that same skilled nursing observation up to the day prior to discharge because there is a "reasonable probability" that a complication or further acute episode can occur, then the daily skilled care requirement would be met.

Examples of skilled services that can be captured prior to discharge -

http://www.cms.hhs.gov/manuals/Downloads/bp102c08.pdf

• Observation and Assessment of Patient's Condition, pp 24-25
  
• Teaching and Training Activities, pp 25-26

Bottomline is, you must show proof that the daily skilled service was still needed AND provided up to that day prior to discharge.