To Judy re:transfer
Hi, this is not Lori--it\'s Eileen Doll.
You last explanation said only that the resident \"moves hands and feet as directed by staff...\"

If he moves his hands to attach or remove lift pad \"chains\", to actually use the electronic control himself, or to hold onto arms of chair to control his body placement as he is lowered into chair, then he is assisting in the transfer. Does he stand up on one leg to remove, or for staff to place lift pad into the chair? That, also, is \"assistance.\"

In long term care, we usually consider a \"mechanically lifted\" resident as totally dependent for a transfer. But participation in any step of the transfer is \"assistance.\"

Many persons are able to use a mechanical lift with only \"set-up\" help from staff or caregiver. 

Lori, He moves himself to assist in pad placement and moves hands and feet as directed by staff for safe transfer from bed to w/c 

Hi Judy

I have been at a conference and just received your question. can you please provide additional information to me regarding how the residnet participates in the transfer?
Thanks Lori 

Lori,
Mr. B. is initially NWB, OOB to w/c with hoyer lift. He is able to move his hands and feet to assist in a minimal way. I\'ve read p 3-87 and code one way, another MDS person codes differently. Please give us the correct answer. Thanks,
jskinner@jhe.org 

According to the Medicare Benefit Policy Manual, In part: skilled nursing requires the skills of qualified technical or professional health personnel and must be provided directly by or under the general supervision of these skilled nursing personnel to assure the safety of the patient and to achieve the medically desired result. If the inherent complexity of a service prescribed for a patient is such that it can be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel, the service is a skilled service. NOTE “General supervision” requires initial and periodic inspection of the actual activity. However, the supervisor need not always be physically present or on the premises when the assistant is performing services. As you can see additinal information is required to answer your question.  

Are regulary scheduled nebulizer treatments enough to keep patient covered under medicare? 

Hi! Just a few more words about this--If the 5-day PPS assessment produces a RUG which falls in one of the top 35 RUGs, Clinically complex thru Rehab with Extensive Serv, the stay is \"PRESUMED\" to be covered thru the ARD of that assessment. This \"presumption\" ONLY applies to the 5 day PPS assessment. However, as Lori stated, the patient still must receive a documented skilled service (meaning that a licensed professional must either perform the service and/or monitor and/or evaluate its effectiveness.)

In this case, IF the physician is trying to stabilize the patient, and orders nightly O2 using either a face mask or cannula or O2 flow rate based on pO2 before and during O2 therapy, this would require the skills and judgment of a licensed nurse. The physician must review and document if and why these services are still required--to \"certify\" the medical necessity. In some cases, the patient\'s history and past instability MAY justify the need for continued monitoring even if the current findings and treatment appear \"stable.\" When a physician documents the judgment he/she used to justify daily skilled treatment for a \"stable\" condition, this claim will rarely, if ever, be denied. 

Hi Dorothy,

Sorry I have not responded to date, however, I have been in the field. To answer your question, I agree with Lisa. Just because a resident receives oxygen in itself does not necessarily constitute a daily skilled service. You need to evaluate what service is actually provided to the resident that can be considered skilled nursing. If the resident is experiencing an acute respiratory episode and requires daily respiratory monitoring and education then the episode may meet the qualifications set by Medicare. 

Hi Dorothy,
Oxygen therapy may place a resident in a clinically complex category, but is not in and of itself a skilled service, unless for a very short time for teaching when it’s a new therapy, or monitoring acute respiratory problems.  

My patient requires oxygen every night per MD order. Medicare denied this claim as being a skilled service despite falling into a covered RUGS code. Can you help explain when oxygen therapy is or is not considered a daily skill? 

ARD is included in the count. 

In a 14 day lookback period do you count 14 days from the ARD or do you count the ARD as one of the days. Also, is a q8hour straight cath considered skill nursing?