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60 day wellness period/part B benefits

MDS   (5,879 Views 4 Comments)
by kjMDSnurse kjMDSnurse (New Member) New Member

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We have a patient who exhausted part A benefits but continued to need PT/OT and was picked up under the part B benefit. Does the need for continued rehab keep the patient from starting a 60 day wellness period? Also, wouldn't that patient have to have a sixty day wellness period before regaining any benefits, even if the person was readmitted with a different diagnosis? First hospitalization and skilled stay was for a hip fracture; spent a week in the hospital and was readmitted with a diagnosis of CHF.

Thanks for any help.

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Talino works as a SNF/MDS/PPS Consultant.

15,510 Visitors; 920 Posts

You are correct. The patient must be skilled-free (or discharged home) and not hospitalized for 60 consecutive days.

Day 1 begins after the last day of skilled care. When the patient is admitted to a hospital before the 60th day, the wellness period is lost, meaning the day of return to facility is again day 1. And, when skilled service is provided, day 1 restarts after last day of skilled care.

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susanthomas1954 has 35 years experience and works as a MDS coordinator.

4,094 Visitors; 195 Posts

Our company says that part B doesn't demonstrate a DAILY skilled need, thus when the med A exhausts and rehab picks up for part B, the pt can be skilled again after sixty days if no hospitalization in the mean time. Best to check with CMS, I think.

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Talino works as a SNF/MDS/PPS Consultant.

15,510 Visitors; 920 Posts

our company says that part b doesn't demonstrate a daily skilled need.

... meaning you can bill med b even if therapy is provided less than 5 days a week. in which case, the service is non-skilled. as long as it is clinically indicated, you can continue to provide therapy on a "daily basis" while under med b, hence, rises to a skilled level of care.

30.6 - daily skilled services defined p32

skilled nursing services or skilled rehabilitation services (or a combination of these services) must be needed and provided on a "daily basis," i.e., on essentially a 7 days a week basis. a patient whose inpatient stay is based solely on the need for skilled rehabilitation services would meet the "daily basis" requirement when they need and receive those services on at least 5 days a week. (if therapy services are provided less than 5 days a week, the "daily" requirement would not be met.)

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