Peg and wellness period

[TigerxLiLy]

I have been told that a PEG that is giving a patient 26% or more of daily nutrition is considered a skilled service in a LTC setting.

Was told that when the patient uses their 100 days that they would never accrue the 60day wellness period as long as the above was still effective in a LTC setting.

Is this accurate? It seems the medicare guidelines are vague in the aspect of what is considered "skilled" sometimes...

[Talino]

Benefit Period Explained p18

How long does Medicare cover my SNF care?

Medicare uses a period of time called a benefit period to keep track of how many days of SNF benefits you use, and how many are still available. A benefit period begins on the day you start getting inpatient hospital or SNF care. You can get up to 100 days of SNF coverage in a benefit period. Once you use those 100 days, your current benefit period must end before you can renew your SNF benefits. Your benefit period ends:

1. When you haven't been in a SNF or a hospital for at least 60 days in a row.
   
2. If you remain in a SNF, when you haven't gotten skilled care there for at least 60 days in a row.
   

Enteral feeding that comprises at least 26 percent of daily calorie requirements and provides at least 501 milliliters of fluid per day (Skilled Nursing Services p32) is a daily skilled care. As long as the resident meets the criteria, the benefit period doesn't end and the 60-day wellness period can not commence.

[TigerxLiLy]

Thank you Talino. I swear i have read the medicare guidelines - guess i just remember reading it- and sorta related it to my corporate office (maybe thought it was their rules.. Who knows)

Just ran into this issue when we admitted a new patient from a sister facility of ours... I told our administrator that the patient didnt have a wellness period based off our calculations.

Was skilled at other facility for a hip fx from 4/29 to 8/7- used all 100days.

Then on 8/28 it is noted in hospital records that she obtained a PEG due to not eating orally- breaking the wellness period.

She admitted to psych unit on 10/27 - h/p notes she was recieving TF and pleasure trays at other SNF. She recieved 80cc/hr x12hr feedings at hospital.

Administrator, DON and Myself felt assured that resident did not meet her requirements for skilled care.

Yet, the other SNF was skilling her for 5 days prior to admitting to us...