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Question on Skilling

Posted

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Resident was not on Med A for 120 days. Had one week of therapy 3 times a week billed out to Med B. Went to the hospital for more than the required 3 overnights. WE think he comes back with 100 days of Med A. Corporate (Who doesn't really know), says no because he was 'on therapy' and never off skill. WE say 3 times a week therapy is not skilled.

Please, can someone point me in the right direction.

Thanks.

Talino

Specializes in ER CCU MICU SICU LTC/SNF.

30.6 - Daily Skilled Services Defined

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.)

Medicare Benefit Policy Manual Chapter 8 p32

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Thanks...as always you come through with the info I need.