MDS Alert
To Reskill Or Not To Reskill This Resident In The 30-Day Window
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Question: Our SNF admitted a 69-year-old resident for rehab after a hip repair. He had a documented history of COPD and some indication of hypostatic pneumonia developing in the hospital. Our care plan included aggressive interventions to prevent hypostatic pneumonia, including deep breathing exercises and monitoring. We discharged him from skilled care once he plateaued in his rehab therapy, and we didn't perform an OMRA because he didn't have a daily skilled nursing need at that time. Yet now, 20 days later, he has developed viral pneumonia and requires oxygen and IV fluids. He refused to go to the hospital, so we are treating him in the facility. Since he's within the 30-day window from discharge and has 45 days left in his benefit period, can we reskill him even though the viral pneumonia wasn't a condition treated in the hospital stay or during his Part A stay? Answer: You are correct that you can reassign the resident to a Medicare stay within 30 days of the last covered skilled day. Although the viral pneumonia was not treated in the hospital, the COPD most probably was. And the resident's respiratory system was jeopardized secondary to the fracture, subsequent surgery and overall debilitated condition. I would put him back on Medicare. Source: Marilyn Mines, RN, RAC-C, BC, manager of clinical services for FR&R Healthcare Consulting in Deerfield, IL.
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