Category: Ask the Experts

Ask our expert your MDS3.0 questions

Ask the Expert: Restraint use coded on MDS

Q: We have had residents who are inmates of the sheriff’s depart.  Because of being in the custody of the sheriff’s department the resident has to be handcuffed to the bed or w/c at all times.  They usually are not in restraints due to the facilities policies, but due to sheriff’s department policy.  How should this […]

Ask the expert: 100 day Medicare benefit

Q: If a stroke patient uses 100 Medicare days in a skilled nursing facility, and then after 60 days of wellness, incurs a new hospital stay for a kidney infection, could the patient qualify again for the 100 days of Medicare in a skilled nursing facility? A:  After using the 100 Medicare Part A SNF benefit, and […]

Ask the expert: Medicare Advantage

Q: How do I know if my resident is Traditional Part A or has a Medicare Advantage Plan? My confusion comes into play when the Business office admits a Medicare Part A patient into our skilled nursing facility, but then I see copies of insurance cards that say Blue Cross Anthem, Blue Shield, Secure Horizons, AARP, […]

FREE Consolidated Billing white paper

Consolidated billing can be a complicated task. Sign up to receive a FREE white paper featuring a sample of questions and answers highlighted in a recent HCPro webcast, “SNF Consolidated Billing: Who Really Has to Pay All These Invoices?” presented by long-term care billing expert Janet Potter, CPA, MAS. The top 3 questions answered in this white paper include: Q: […]

Ask the expert: qualifying stay

Q:What are the rules regarding a qualifying hospital stay at a hospice inpatient facility? Can a stay at a hospice inpatient facility be used as a qualifying hospital stay for a skilled nursing facility? A: The regulations are pretty clear that the hospice would need to meet the definition of a hospital.  Most inpatient hospice facilities […]

Ask the expert: 60 days of wellness

Q: If a hospital admission starts the 60 day spell of illness, then do days spent in the hospital not count? A: A hospital admission of 3 consecutive days is a requirement to begin a spell of illness, which is 100 SNF days in the complete spell of illness. After using the 100 hundred days, a beneficiary […]

Ask the expert: Medicare Advantage

Q:  We have a resident being admitted with a new G-tube, NPO status and receiving all nutrition via tube feeding.  The resident is Medicare Advantage (Humana).  Under the Medicare Benefit policy manual this would be considered a direct skilled nursing service, so we could potentially skill this resident for 100 days since it is the beneficiary’s […]

Ask the expert: Wellness

Q:  I have a resident who was readmitted to the hospital on his 60th day of his spell of wellness. Did he break the spell of wellness on day 60? Is he entitled to a new benefit period, or did he have to be on day 61 to begin a new benefit?   A: Unfortunately, it had […]

Ask the expert: Observation time

Q: Does a spell of wellness end with observation time in a hospital?   A: Technically, it ends with a hospital admission.  Observation status is not addressed as one of the two variables.  

Ask the expert: Medicare coverage

Q: If a resident used 100 days with the peg tube at another facility, stays in that facility more than 60 days after they have a 3-day hospital stay, can we pick up under Medicare and skill for PT/OT even though resident still has the peg tube? A: If the other facility is a Medicare certified facility […]