Ask the expert: Tube feeding

Q: Regarding tube feeding, I have a resident who resides in a SNF, she receives only flushes, no nutrition via PEG tube. She was skilled for a tube in the past (2013), but has not received any nutrition for a year; does she qualify for another benefit period? She is still receiving flushes with occasional feeding.
A:  Once a resident no longer has a skilled PEG tube (I.e., less than 26% of the calories and less than 501 …

Ask the expert: Ambulance billing

Q: I work in ambulance billing.  I know that under Original Medicare, many non-emergent transports of bed confined and non-wheelchair patients is billable to the SNF.  Is the same true for Medicare Advantage plans? Also, is there some way to tell when to bill the SNF?
 
A:  Medicare Advantage plans are not subject to consolidated billing rules, but are subject to Medicare coverage guidelines. If the transport does not meet the Medicare coverage guidelines, then Medicare cannot be …

Ask the Expert: Restraint use coded on MDS

Q: We have had residents who are inmates of the sheriff’s depart.  Because of being in the custody of the sheriff’s department the resident has to be handcuffed to the bed or w/c at all times.  They usually are not in restraints due to the facilities policies, but due to sheriff’s department policy.  How should this be coded on the MDS?  Is it considered a restraint?
A:  The unusual situation you describe is not addressed in the MDS …

Ask the expert: 100 day Medicare benefit

Q: If a stroke patient uses 100 Medicare days in a skilled nursing facility, and then after 60 days of wellness, incurs a new hospital stay for a kidney infection, could the patient qualify again for the 100 days of Medicare in a skilled nursing facility?
A:  After using the 100 Medicare Part A SNF benefit, and the patient no longer has any skilled services or needs and the 60 days of wellness, then the beneficiary has a …