MDS Alert

Question: Our facility has a patient who had been on SNF Part A for rehab. The patient is chronically ill with cancer. When the patient's rehab therapy ended, we gave him a Medicare cut letter.  he patient went to the ER the next day and returned shortly to the SNF with a prescription for oral antibiotics to treat chronic UTI caused by a suprapubic catheter. The patient also had eschar on his heel with dry dressings ordered daily. He is receiving insulin on a sliding scale. The physician's note stated the patient is stable and receiving supportive care.

Should we have rescinded the cut letter and kept him on Medicare due to his medical condition?

Answer: The key to determining skilled level of care is to determine what skilled service the resident requires and receives on a daily basis, says Ron O rth, RN, N HA, CPC, RAC-MT, president of Clinical Reimbursement Solutions in Milwaukee. "In order to best answer this question, more information about the resident's clinical status would need to be known. Why was the resident sent to the ER? What signs/symptoms is the resident having that led to the ER visit? Does the resident continue to havethese signs/symptoms?" he asks.

"While the provision of [oral] meds (including antibiotics) does not constitute a skilled service, the resident may have required skilled nursing observation and management due to the UTI and other multiple health conditions until the resident is essentially stabilized," he says. Here is what the Medicare Benefit Policy Manual states in relation to skilled observation and assessment, Orth says:

"Observation and assessment are skilled services when the likelihood of change in a patient's condition requires skilled nursing or skilled rehabilitation 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."

Source: www.cms.gov/manuals/Downloads/bp102c08.pdf.