If a resident is cut from skilled services but a new skilled need arises during the interrupted stay window, would the facility be allowed to re-skill the resident?



The Medicare Benefit Policy Manual, Chapter 8 states that “Another qualifying hospital stay would not be required, providing the care furnished is clearly related to a hospital stay in the previous spell of illness and represents care for which the need was predicted at the time of discharge from such hospital stay.” If a resident readmits during the interruption window with a new unrelated condition, the resident would not be eligible for skilled care as the new condition would require a new qualifying hospital stay.

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

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