skilled need

annaedRN, RN · Feb 25, 2010

this is a copy and paste from a medicare website

1. a skilled nursing service is a service that must be provided by a registered nurse, or a licensed practical (vocational) nurse under the supervision of a registered nurse, to be safe and effective. in determining whether a service requires the skills of a nurse, consider both the inherent complexity of the service, the condition of the patient, and accepted standards of medical and nursing practice.

some services may be classified as a skilled nursing service on the basis of complexity alone, e.g., intravenous and intramuscular injections or insertion of catheters, and if reasonable and necessary to the treatment of the patient's illness or injury, would be covered on that basis. however, in some cases the condition of the patient may cause a service that would ordinarily be considered unskilled to be considered a skilled nursing service. this would occur when the patient's condition is such that the service can be safely and effectively provided only by a nurse.

-observation and assessment of the patient's condition by a licensed nurse are reasonable and necessary skilled services when the likelihood of change in a patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment or initiation of additional medical procedures until the patient's treatment regimen is essentially stabilized. where a patient was admitted to home health care for skilled observation because there was a reasonable potential of a complication or further acute episode, but did not develop a further acute episode or complication, the skilled observation services are still covered for 3 weeks or as long as there remains a reasonable potential for such a complication or further acute episode.

3. teaching and training activities.--teaching and training activities that require skilled nursing personnel to teach a patient, the patient's family or caregivers how to manage his/her treatment regimen would constitute skilled nursing services. where the teaching or training is reasonable and necessary to the treatment of the illness or injury, skilled nursing visits for teaching would be covered. the test of whether a nursing service is skilled relates to the skill required to teach and not to the nature of what is being taught. therefore, where skilled nursing services are necessary to teach an unskilled service, the teaching may be covered. skilled nursing visits for teaching and training activities are reasonable and necessary where the teaching or training is appropriate to the patient's functional loss, illness, or injury.

teaching and training activities that require the skills of a licensed nurse include, but are not limited to, the following:

o teaching the self-administration of injectable medications or a complex range of medications;

o teaching a newly-diagnosed diabetic or caregiver all aspects of diabetes management, including how to prepare and administer insulin injections, prepare and follow a diabetic diet, observe foot-care precautions, and observe for and understand signs of hyperglycemia and hypoglycemia;

o teaching self-administration of medical gases;

o teaching wound care where the complexity of the wound, the overall condition of the patient, or the ability of the caregiver makes teaching necessary.

o teaching care for a recent ostomy or where reinforcement of ostomy care is needed;

o teaching self-catheterization;

o teaching self-administration of gastrostomy or enteral feedings;

o teaching care for and maintenance of peripheral and central venous lines and administration of intravenous medications through such lines;

hope this helps a little....if you have specific questions or what constitutes a skilled need, it is very difficult to find an answer. it's all basically on the individual needs of the patients and how a specific service effects them. different family dynamics, patient's motivation and level of ability...all affects how many visits a person may need or how long they require services. just be sure to document the need for further assessment of wound, infection, teaching, cardiovascular status, pain, edema, etc....hopes to help justify the skilled need. oh - and be sure to document homebound status too!!

irene94 · Feb 25, 2010

Thank you that does help. I appreciate teh time you took to help me out.