Long-Term Care

BALTC Q&A

Billing Alert for Long-Term Care, May 1, 2009

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Q: I am new to nursing facility billing and recently attended a seminar in which the speaker stated that, in most cases, a resident with a surgically inserted feeding tube will never qualify for another Medicare benefit period as long as he or she remains in a Medicare-certified bed in the nursing facility. Is it true that once you have skilled a beneficiary requiring tube feeding, the beneficiary can never renew his or her Medicare Part A benefits?

A: First you have to determine whether the Medicare definition for skilled services is met. This can be found in the Medicare Benefit Policy Manual, Chapter 8, Section 30.3. Based on the rules of this section, ¬enteral feeding qualifies as a skilled service when the beneficiary’s nutritional intake is at least 26% of daily calorie requirements and the enteral feeding provides at least 501 milliliters of fluid per day. Use these criteria to determine whether the resident is receiving skilled services that meet the Medicare guidelines.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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