Masters_Healthcare_126
  • Medicare Coverage in Skilled Nursing Centers

    Direct Skilled Nursing Services
    Skilled Therapies
    Nursing Rehabilitation
    Medicare A & B 

    Direct Skilled Nursing Services

    • Injections - IV therapy
    • Nasogastric tube, gastronomy and jejunostomy feedings
    • Naso-phayngeal and tracheostomy suctioning
    • Insertion, sterile irrigation and replacement of catheters and care of a suprapubic catheter
    • Treatment for pressure ulcers/stasis ulcers
    • Heat treatments which have been specifically ordered by a physician as part of active treatment
    • Initial phases of a regimen involving administration of oxygen
    • Colostomy care post-operative
    • Observation and assessment of unstable and post-operate residents
    • Development, management and evaluation of the resident care plan of multiple and complex conditions

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    Skilled Therapies

    Physical Therapy, Occupational Therapy, Speech Therapy must be:

    • directly and specifically related to an active written treatment plan designed by the physician after any needed consultation with a qualified therapist
    • of a level of complexity or the condition of the patient must be of a nature that requires the judgment, knowledge and skills of a qualified therapist
    • provided with the exception that the condition of the patient will improve in a reasonable and generally predictable amount of time
    • specific and effective treatment for the resident's condition
    • reasonable and necessary for the treatment of the resident's condition

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    Nursing Rehabilitation

    Nursing rehabilitation activities which require skilled nursing or skilled rehabilitation personnel to teach a resident how to manage his/her treatment regimen constitute skilled services and including the following:

    • passive or active ROM
    • amputation care
    • splint care
    • training in dressing or swallowing
    • transfers, bed mobility
    • communication
    • scheduled toileting or bladder retraining

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    Medicare Part A & B

    Medicare

    Five Factors Required for Part A Coverage in a Skilled Nursing Facility:

    • the resident requires skilled nursing services or skilled rehabilitation services (requires the skills of  qualified technical or professional health personal)
    • the resident requires these services on a daily basis
    • as a practical matter (economy and efficiency), the daily skilled service can be provided only on an inpatient basis in a skilled nursing facility
    • services must be furnished pursuant to a physician's orders
    • services must be reasonable and necessary, as well as:
      • consistent with nature and severity of illness, and
      • reasonable in terms of duration and quantity
       

    As a Medicare beneficiary, you qualify for healthcare insurance coverage that entitles you to a wide array of benefits.

    As a Medicare provider, we are required to provide you with the combination of skilled nursing and therapy services that will get you to - and keep you at - your highest level of functioning. At Kindred, we call this Medicare entitlement.

    For more information about the Medicare program, please call 1-800-MEDICARE (1-800-633-4227).

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