4142 Bonney Road
Virginia Beach, VA 23452-1711

757.340.0620

MEDICARE COVERAGE IN SKILLED NURSING CENTERS

Direct Skilled Nursing Services

  • Injections – IV therapy
  • Nasogastric tube, gastronomy and jejunostomy feedings
  • Nasophayngeal 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

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

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

Medicare Part A & B

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).