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Med A Skill



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!!!


Specializes in ER CCU MICU SICU LTC/SNF.

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.

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


Specializes in ER CCU MICU SICU LTC/SNF.

]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.