Medicare Coverage in Skilled Nursing Centers
Direct Skilled Nursing Services
Skilled Therapies
Nursing Rehabilitation
Medicare A & B
Direct Skilled Nursing Services
- Injections - IV therapy
- Nasogastric tube, gastronomy and jejunostomy feedings
- Naso-phayngeal and tracheostomy suctioning
- Insertion, sterile irrigation and replacement of catheters and care of a suprapubic catheter
- Treatment for pressure ulcers/stasis ulcers
- Heat treatments which have been specifically ordered by a physician as part of active treatment
- Initial phases of a regimen involving administration of oxygen
- Colostomy care post-operative
- Observation and assessment of unstable and post-operate residents
- Development, management and evaluation of the resident care plan of multiple and complex conditions
Return to top
Skilled Therapies
Physical Therapy, Occupational Therapy, Speech Therapy must be:
- Directly and specifically related to an active written treatment plan designed by the physician after any needed consultation with a qualified therapist
- Of a level of complexity or the condition of the patient must be of a nature that requires the judgment, knowledge and skills of a qualified therapist
- Provided with the exception that the condition of the patient will improve in a reasonable and generally predictable amount of time
- Specific and effective treatment for the resident's condition
- Reasonable and necessary for the treatment of the resident's condition
Return to top
Nursing Rehabilitation
Nursing rehabilitation activities which require skilled nursing or skilled rehabilitation personnel to teach a resident how to manage his/her treatment regimen constitute skilled services and including the following:
- Passive or active ROM
- Amputation care
- Splint care
- Training in dressing or swallowing
- Transfers, bed mobility
- Communication
- Scheduled toileting or bladder retraining
Return to top
Medicare Part A & B
(click illustration to see larger version)
Five Factors Required for Part A Coverage in a Skilled Nursing Facility:
- The resident requires skilled nursing services or skilled rehabilitation services (requires the skills of qualified technical or professional health personal).
- The resident requires these services on a daily basis.
- As a practical matter (economy and efficiency), the daily skilled service can be provided only on an inpatient basis in a skilled nursing facility.
- Services must be furnished pursuant to a physician's orders.
- Services must be reasonable and necessary, as well as:
- Consistent with nature and severity of illness, and
- Reasonable in terms of duration and quantity.
As a Medicare beneficiary, you qualify for healthcare insurance coverage that entitles you to a wide array of benefits.
As a Medicare provider, we are required to provide you with the combination of skilled nursing and therapy services that will get you to - and keep you at - your highest level of functioning. At Kindred, we call this Medicare entitlement.
For more information about the Medicare program, please call 1-800-MEDICARE (1-800-633-4227).
Return to top