We use the letter d/t there isn't always documentation with a dr signature about the medical predictability. Christine PS Thanks for the info where to find the actual regulation
-----Original Message----- From: joelene galie [mailto:[EMAIL PROTECTED] Sent: Wednesday, April 28, 2004 9:07 AM To: [EMAIL PROTECTED] Subject: RE: Question Re: letter of predictability Check Medicare Benefit Policy Manual 20.2.2.1 Medical Appropriateness Exception - example given is hip fracture with wgt bearing limitations at discharge/ 20.2.2.3 addresses starting skilled stay then delaying because of limitations. In both instances it needs to be medically predictable at the time of discharge from acute care. There is no mention of a letter being required. We use the data from the transfer sheet as designation of cause ( limited weight bearing) and time frame(followup 4-6 weeks). The manual also states that this is an established pattern of treatment for hip fractures - what more should you need? >From: "Ann Schoeny" <[EMAIL PROTECTED]> >Reply-To: [EMAIL PROTECTED] >To: <[EMAIL PROTECTED]> >Subject: RE: Question Re: letter of predictability >Date: Wed, 28 Apr 2004 08:01:19 -0400 > >What about this scenario: A hip fracture is admitted and has non weight >bearing status to that leg. We provide other therapy that is appropriate. >The WB status does not change and we have to cut from therapy d/t plateaued >in other areas. They go past 30 days since being skilled. Then at day 45 >they have ortho appt., and restrictions are lifted. Can you use the letter >at any time during this period, say when the therapy is d/c'd? >This has happened to us and we have to pick up under part B. >ann m schoeny crnac >sem haven nursing and rehab >225 cleveland ave. >milford, ohio 45150 >(513) 248-1270 > >-----Original Message----- >From: Sam Curran [mailto:[EMAIL PROTECTED] >Sent: Tuesday, April 27, 2004 11:20 PM >To: [EMAIL PROTECTED] >Subject: Re: Question Re: letter of predictability > > > If I understand the following scenario of a resident admitted to >Medicare Part-A but reached a point where additional therapy was to be >delayed for 6 to 8 weeks until weight bearing status changed, the resident >would not be eligible for coverage under Part-A unless "medical >predictability" was documented at the time of the hospital discharge. If >the "medical predictable" delay was documented at the time of discharge >from the hospital then the resident could be picked back up on Medicare >Part-A when he/she reaches weight bearing status. Under the 30-day >transfer requirements "medical predictability" for Medicare coverage only >occurs at the time of hospital discharge. The "medical predictable" >exception to the 30-day transfer requirements exists to insure the skilled >nursing care a resident receives is for continuation of care provided in >the hospital. Reference chapter 8 of the Medicare Benefit Policy Manual or >Part-3 of the Medicare Intermediary Manual. > > I've discovered from experience that if a claim involving "medical >predictability" goes to medical review or to an ALJ hearing the preferred >type of verification is on a document from the hospital that was issued on >the same day the resident was discharged from the hospital. This is >especially important if the resident goes home for a period of time before >admission to the skilled nursing facility to receive therapy. > >S.A. Curran > >[EMAIL PROTECTED] > > ----- Original Message ----- > >From: [EMAIL PROTECTED] >To: [EMAIL PROTECTED] >Sent: Tuesday, April 27, 2004 4:52 PM >Subject: Re: Question Re: letter of predictability > > >In a message dated 4/27/2004 10:19:51 AM Eastern Standard Time, >[EMAIL PROTECTED] writes: > > > >I believe per the Medicare ruling that the letter of predictability has to >be signed before admission. I don't have the exact area to find the >documentation for this rule. That is what I have been taught over the >years. > > > > >We have a scenario right now where resident has FX ankle, NWB on skilled >therapy for transfers, balance, ADL's, etc. Now at max level but want to be >able to pick up again in 6-8 weeks when wt bearing. Does the letter of >predictability apply here or does it have to be done prior to admission to >the SNF? Thanks for your help > _________________________________________________________________ FREE pop-up blocking with the new MSN Toolbar - get it now! http://toolbar.msn.com/go/onm00200415ave/direct/01/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/ NOTE: This e-mail message may contain information that is privileged, confidential, and exempt from disclosure. It is intended for use only by the person to whom it is addressed. If you have received this message in error, please do not forward or use this information in any way. 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