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Discussion

Skill or not to skill!?

Had a man come in 6/1-- he was at another facility from oct 2-dec 3 2011. He admitted to that facility with a peg tube on oct 2 due to stroke. They say they only skilled for pressure ulcer(not tube) for 60 days(dec 2) and then he went to LTC (only used 60 out of 100 days) On 4/24 he went to hospital (more then 60day wellness period). Then came to us on 6/1... Is he still skillable? Does he get all 100days back?

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    And he gets 100% of nutrition thru tube

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    I suggest you have the biller call your FI's IVR and find out when the last claim for skilled service was made and for how many days. Technically there were two skillable services after the resident experienced a stroke. Ideally, the skilled service would have continued for the PEG (calorie/fld requirements met) when the pressure ulcer was resolved.

    If the claim for skilled care was indeed only for 60 days, he can only use the remainder of that benefit, 40. Since the resident had the PEG, he continuously received skilled care while in the facility. Hence, there was no 60-day wellness period.

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