Long-Term Care

Ask the expert: Medicare Advantage

MDS 3.0 Insider, October 31, 2014

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Q: We have a resident being admitted with a new G-tube, NPO status and receiving all nutrition via tube feeding. The resident is Medicare Advantage (Humana). Under the Medicare Benefit policy manual this would be considered a direct skilled nursing service, so we could potentially skill this resident for 100 days since it is the beneficiary's need for skilled care. It has been my understanding that Medicare Advantage plans follow the same guidelines as Medicare Part A, as per the Medicare Benefit Policy Manual. However, when our Business Office contacted Humana regarding this particular resident, they said they would not be able to cover for 100 days on the need for skilled services for the tube feeding. Is this correct?
 
 To read our Regulatory Specialist’s response, visit MDSCentral.



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