Tag: skilled services

CMS launches Jimmo Settlement Agreement webpage

Looking for information about the Jimmo Settlement Agreement? Visit the new Jimmo Settlement Agreement webpage for: Background on the settlement Links to resources Frequently Asked Questions (FAQs) CMS reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s […]

25 national organizations join AHCA in letter to CMS regarding observation stays

On June 20, 2017, a broad coalition of beneficiary and provider advocacy groups submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) in response to the matter of observation stays in hospitals, an ongoing issue that prevents thousands of beneficiaries from being able to access their skilled nursing benefit because of […]

CMS orders post-pay audit of SNF PPS claims

The Supplemental Medical Review Contractor (SMRC) is charged with conducting nationwide medical review as directed by the Centers for Medicare & Medicaid Services (CMS). Topics and timeframes for these reviews are dictated by CMS and are chosen to address specific agency interests regarding coverage, coding, payment, and billing practices. On March 17, 2017, SMRC announced […]

Evidence-based criteria for determining whether services are skilled

Editorial Note: This post is an excerpt from HCPro’s title Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement by Elizabeth McLaren. Chapter 8 of the Medicare Benefit Policy Manual, Section 30.2.2 (“Principles for Determining Whether a Service is Skilled”) starts to look more closely at the criteria for assessing a skilled need. […]

Congress reintroduces bill to count observation stays as three-day prerequisite for SNF coverage

Congress has reintroduced a bill that would ensure patients receiving hospital care under “observation status” could count that time as part of the three-day inpatient hospital stay required to receive skilled nursing care coverage under Medicare. The Improving Access to Medicare Coverage Act of 2017 (HR 1421) mirrors a similar bill introduced in 2015. In […]

Ask the expert: Tube feeding

Q: Regarding tube feeding, I have a resident who resides in a SNF, she receives only flushes, no nutrition via PEG tube. She was skilled for a tube in the past (2013), but has not received any nutrition for a year; does she qualify for another benefit period? She is still receiving flushes with occasional feeding. […]

Ask the expert: Skilled care confusion

Q: When a resident in a SNF exhausts their 100 days of Medicare, can they be re-skilled after a 3-day hospital stay if they have been on a tracheotomy tube the whole time? A: In order to generate a new 100 day benefit, the beneficiary needs to go 60 consecutive days without skilled care being […]