Medicare Part A Skilling and MORE!

Today we will be discussing the Medicare meeting, otherwise known as the beneficiary review meeting.  This meeting is set up so that the interdisciplinary team can discuss the clinical status of a patient and whether that patient continues to meet the criteria for skilling under their Medicare Part A benefit.  This meeting provides an opportune time to review the Medicare Part B beneficiaries or your managed care patients during this meeting.  The goal of the meeting is not to focus on when the patient is going to be discharged.   This is not a discharge planning meeting, the meeting is designed to review what the skilling criteria or the needs on a daily basis of the patient from nursing and from therapy. Kris B Harmony recommends that the entire interdisciplinary team attend this meeting and that each member of the team be aware of what they are going to be reporting on during the meeting.  For example, the business office would be discussing how many days the patient has used in their benefit period or how many days the patient has left.  MDS may be discussing what the potential selected ARD date is.  As well, MDS may discuss ADL assistance provided to the patient to make sure that team members are in agreement with the level of assistance provided to assure levels are accurately reflected on the MDS.  Nursing should be talking about why the patient requires daily skilled care and therapy should talk about the patient’s status in relationship to their ability to continue to provide daily skilled care to the patient.  Again, this meeting is so that the team can assure that the facility is accurately utilizing the patient’s  Medicare Part A benefit.

Beneficiary Review Meeting Tips

• Entire team attends Medicare meeting
• Each member has an assigned portion of information to discuss
• Key Question: Why does the patient require daily skilled nursing and/or therapy?
• The entire team should be aware of the skilling criteria for care of each individual patient.

The most important thing which needs to be discussed at the Medicare meeting is why the patient requires daily skilled care from nursing and from therapy.  The entire interdisciplinary team should hear the skilling reasons from each of the different disciplines that are providing skilled care to a patient.  The daily skilled criteria should be openly discussed so that everybody understands what assessments and therapeutic interventions are being provided to the patient, therefore this particular piece gets recorded in the medical record.