Eli's Rehab Report

Published on Mon Jun 14, 2010 PDF

Question: If a Medicare Part A resident, long or short term, who is receiving therapy services, goes to the hospital and returns two to three days later without significant functional change, do we have to perform a discharge on the day the patient was sent out and another eval following the patient's return to the facility? Also, if we anticipate that the resident will return in a few days, despite admission to the hospital, can the therapist document "no significant change" and continue with the previous plan of care?

-- Mississippi Subscriber

Answer: Under Medicare Part A, if a resident is formally admitted to the hospital (and not just under observation), you must do a new evaluation, as the patient will have to have restart their Medicare assessment clock to day one.

See the language from the RAI manual: "Therapies that occurred after admission/readmission to the nursing facility, were ordered by a physician, and were performed by a qualified therapist (i.e., one who meets State credentialing requirements or in some instances, under such a person's direct supervision) following an initial evaluation upon admission or readmission" (pg 3-185).

If the patient is under Medicare Part B, no regulations dictate a discharge and new evaluation when a patient is discharged from the nursing home and readmitted. You may, however, want to do a re-evaluation if there is a significant change in medical status. If you need to change the long-term goals because the patient's status has changed, you would need to do a new certification. But if nothing has really changed with the patient's medical or functional status, you can proceed.

Tip: Have the therapist, not an assistant, see the patient for the first session after he is readmitted to assess if the existing plan of care remains appropriate from a clinical perspective.