Can you continue to skill with a resolved diagnosis? We have been discharging resident from skilled services once the active diagnosis is resolved example: UTI, E. coli, and pneumonia. Are we correctly doing this?



Providers should assess the resident’s need for skilled services based on the whole clinical picture. Skilled coverage requirements as stated in the Medicare Benefit Policy Manual, Chapter 8 include that the reason for skilled care must be for services “rendered for a condition for which the patient received inpatient hospital services or for a condition that arose while receiving care in a SNF for a condition for which he received inpatient hospital services.” Once a condition is resolved it could be presumed that services are no longer being rendered for that condition. However, the interdisciplinary team should take into consideration potential ongoing reasonable and medically necessary therapy services. If the patient continues to exhibit ADL and mobility declines as a result of the primary condition, skilled days may be required to complete the rehabilitation discharge goals. Again, the primary diagnosis should be the reason for skilled Medicare coverage in the SNF. Using pneumonia as the example, not every person with pneumonia requires SNF care; is pneumonia truly the condition that requires skilled services, or is there an underlying chronic condition that requires admission to the SNF rather than treatment at home?

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Blog by Eleisha Wilkes, RN, RAC-CT, RAC-CTA, Proactive Medical Review

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