Skilling Factors

[southernbeegirl, BSN, RN]

Morning everyone!

I have some questions.

Can you skill a patient for nursing observation for 14 days? I always understood you could skill for 7 days for nursing obs but that was it. Now we are being told we can skill for 14 days for no other reason but obs.

Can you skill a dialysis patient for the whole 100 days just for dialysis? We are being told this is also possible. As nurses on the floor, we dont understand this. what are we doing that qualifies as SNF? what do we need to chart on daily? the way we see it...other than monitoring the fluid status, and monitoring after dialysis itself...what are we doing for them? the dialysis centers take care of the CVLs, we dont do much at all for them.

any and all opinions appreciated. thanks!

[debRN0417]

Are these residents also receiving rehab services? A little PT, OT or SLP, can also be a skilling factor. Sometimes Restorative, wound care, all that stuff too. It depends on their assessments and charting as well. There must be someone overseeing the process and documentation because if/when the Medicare/Medicaid auditors come in..well, that would speak for itself. As a nurse, I would only concern myself with the facts...what is wrong with my resident, what are my responsibilities to my resident, what does the care plan call for, what are the requirements for documentation, I assess every shift and document, I observe and monitor for any changes and report immediately and document, I administer medications correctly and knowledgeably, and document accordingly. I make sure that dressings and treatments are done per order, vital signs per order and document. I make sure that they are eating and if need supervision or feeding that is done and document....I follow professional standards of practice for each one of my residents...in a nut shell, if I were a floor nurse, I would not worry about what was skilling my resident, but what I needed to do to care for them. I understand though your question...why not ask the DON?

[poohmdsnurse]

Well first off I know as a MDS nurse who does the billing- I get paid on the first 5 day MDS for 14 days, so that is why they are telling you to skill them for 14 days. Your place of employment would lose 7 days of $$$ say if you get a SE3 it would be $250-300 a day= $2,000 grand they are throwing out the window.

And for skilling for dialysis purpose- yes you can skill for 100 days and they will remain a skilled status for eternity according to the new guidelines with Medicare. I personally skilled a patient for dialysis- he received IV fluids also.

[noc4senuf]

We only skill them for observation for the first 5 days, if they do not have therapies or anything else nursing can cover them on. As for the dialysis, I have one resident right now that was given a denial on the 4th since all he had was the dialysis (long standing). He had only been attending therapy two days per week and now he does not even do that. The family has a meeting with myself and the NHA today since they want to keep him on Medicare and not pay privately for the room ($9 - $11K per month). The family did not appeal in the appropriate timeframe since they "did not have time" to make the one phone call to do so.

The resident has now acquired pneumonia but, it was not an admitting diagnosis (and also a chronic recurring problem) so we will not be putting him back on medicare. We always incourage families to appeal but, we do not tell them tht we haev never lost in an appeal eitherso, we must be doing something right.