60 day wellness period/part B benefits

[kjMDSnurse]

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.

[Talino]

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.

[susanthomas1954]

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.

[Talino]

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.)