Med A Skill

[Cecilianurse]

Experts,

I have LTC resident that was skilled for a Stage 4 sacral wound for the her Med A - using all 100 days. Had a 60 day wellness then went out again for dx of UTI with PO/ABT/10days. All within this year. I have her on MED A right now, but my question is - Can I skill her again for the same sacral wound? It was a deep wound and hasn't fully healed. Current measurement 3x2.8x1cm.

If I cannot use the wound, I plan to skill her under Med A for at least 10 days since ABT is only PO. Or any suggestion would help.

Thank you!!!

[Talino]

When you say she had a 60-day wellness period, does that mean the St IV sacral ulcer you initially provided skilled service was resolved or reduced to a St II or less? If this ulcer hasn't changed in Stage, even if it changed in size, the skilled level of care would not have ceased.

If the sacral ulcer simply recurred after a 60-day or more of absence, was present during hospitalization, then you can skill the resident again for that condition.

[Cecilianurse]

The sacral wound just reduced in size and still present when discharged to hospital. Does this mean she cannot be covered under Med A?

[Talino]

]Technically, no since the 60-day wellness period was never achieved. This is no different with a resident who is on a continuous tube feeding. Check with your Medicare biller. When a resident exhaust benefits but continues to require skilled care, the facility has an obligation to submit "benefit exhaust bill" monthly to the FI. This enables CMS to track a beneficiary's benefit period.