Q: We have a resident who has received dialysis treatments for years, has used 100 Medicare days and is now beyond the wellness period, and was recently hospitalized for amputation. He has remained in the skilled nursing facility and has continued to receive dialysis treatments. Can he have a new stay of illness and be picked up under Medicare again?
A: I’m going to assume that the patient was considered benefits exhaust, but still skilled for the duration and that the UB-04 bills reflected this on a monthly basis. If this is the case, then the patient never accrued a new 100 days due to the lack of a break in skilled service. In this case, no new benefits are available under Medicare Part A until the patient goes 60 consecutive days without receiving skilled care and 60 days without a hospital admission (IOM-02 Medicare Benefits Policy Manual, Ch. 8, §30).