Is it cost effective to keep a dialysis resident skilled (i.e., transportation costs, etc.) if the resident’s back-up is Medicaid?
Q: Is it cost effective to keep a dialysis resident skilled (i.e., transportation costs, etc.) if the resident’s back-up is Medicaid?
A: What determines skilled level of care is the clinical condition of the resident rather than cost of care. Medicaid is always the payer of last resort. If benefits are available from any other source, including Medicare, they must be exhausted before Medicaid is billed. If the resident meets the Medicare skilled coverage criteria listed in Internet Only Manual 100-02 Medicare Benefits Policy Manual, Ch. 8, Section 30.2, and has days available in his or her benefit period, then the resident would be covered by Medicare until those benefits are exhausted.
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Diane Brown
Diane Brown is a long-term care regulatory specialist and lead educator for HCPro's MDS 3.0 Boot Camp and Medicare Boot Camp-Long-Term Care Version. She is also a long-term care consultant with over 25 years of operational experience in healthcare. For Diane's complete bio, visit the About page.
Diane has written 240 posts.
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Comments
COULD I GET THE LINK TO THAT ONLINE ONLY MANUAL?
THANKS
Hi Jane,
Internet only manuals are available at the following link:
http://www.cms.gov/Manuals/iom/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS018912&intNumPerPage=10
I hope this helps! Best,
Justin
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