We recieved orders for SN and PT from nursing home. SN went to admit and
during admit Pt decided not to have any discipline except PT. PT did not
go out until next day. Can we bill the admit since we had orders for SN
and did not know that Pt was going to refuse?

Ann Stephen
Stephen's Health Care


  • edited May 2017
    My understanding is that as long as a skill was provided and you have an order, the visit may be billed. Nursing does the admission, then transfers the case to PT and nurses close.
  • edited May 2017
    Nursing must be intermittent to be billable. So if no orders for a second visit, nursing is not billable even if a skill is provided as nursing established the SOC date

    Susan G. Johnsen, RN, MSN, COS-C
    Director, Patient Care. LLUMC Home Health Care
    ph: 909 558 3285

    “Excellence is the Result of Habitual Integrity.”
    Lennie Bennett
  • edited May 2017
    This is from CGS’ web site

    One-time Skilled Nurse
    One-time Skilled Nurse visits , although not considered intermittent, can be billed if the answer is "yes" to either of the following:
    Are there orders or intent to return?
    Usually a one-time skilled nursing visit will not meet the intermittent criteria (when skilled nurse is the only qualifying skilled service). Occasionally a situation will occur when initially there appears to be a need for medically necessary, intermittent skilled nursing visits, but after the first visit the need for additional visits is not necessary (e.g., the beneficiary is institutionalized, dies, or requests no further services when the nurse attempts to return, etc.). In these situations, because the intent is to provide more than one visit, the one-time visit would be covered.
    Was therapy involved or ordered at time of SN visit?
    If the beneficiary requires skilled therapy services, and the therapy services qualify the beneficiary for the home health benefit, then a one-time skilled nursing visit would be payable under Medicare (when all other criteria are met).
    Posted: 09.27.11

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