Medicare Reimbursement in a Skilled Nursing Facility?
Jim Sedlak
Description
Collection
Title:
Medicare Reimbursement in a Skilled Nursing Facility?
Creator:
Jim Sedlak
Date:
5/13/2015
Text:
I am looking for some help regarding reimbursement by Medicare for a level 1
AK amputee in a skilled nursing facility.
Patient is a 90 year old AK patient that just recently was put into a
Skilled nursing facility. He is on his Medicare B. Patient is a long time
Prosthetic user (70 plus years). I am not exaggerating when I say his
current prosthesis is probably over 50 years old. He has done very well
over the years with the prosthesis. However, he now has dementia, and has
become incontinent. He wears the leg all the time, and uses it primarily
for transferring and very limited walking (Functional level 1). However,
just recently he has been retaining fluids for whatever reason, and the PT
and nursing can no longer get the leg on all the way. They now have to use
a lift for transferring with the leg not functioning and fitting properly.
The PT staff and family want to explore fitting for a more appropriate
prosthesis. Not just because he can no longer function with the prosthesis
because it does not fit properly, but also due to the incontinent issues.
With the socket being made of leather and corset with a shoulder harness,
every time he has an accident, the excess gets soaked up in the materials of
the prosthesis and has become a major hygienic issue.
We discussed the possibility of fitting with a 1 piece thermoplastic socket
and using a Silesian belt for suspension. With a 2nd belt for easy
replacement for easy cleaning. We would be looking at a completely new leg
for obvious reasons, as I would not be able to work with the 50 year old
plus existing componentry. I just want to make sure I am going to get
reimbursed by Medicare.
TIA!
Jim Sedlak, CP
Prosthetic HealthCare Services
AK amputee in a skilled nursing facility.
Patient is a 90 year old AK patient that just recently was put into a
Skilled nursing facility. He is on his Medicare B. Patient is a long time
Prosthetic user (70 plus years). I am not exaggerating when I say his
current prosthesis is probably over 50 years old. He has done very well
over the years with the prosthesis. However, he now has dementia, and has
become incontinent. He wears the leg all the time, and uses it primarily
for transferring and very limited walking (Functional level 1). However,
just recently he has been retaining fluids for whatever reason, and the PT
and nursing can no longer get the leg on all the way. They now have to use
a lift for transferring with the leg not functioning and fitting properly.
The PT staff and family want to explore fitting for a more appropriate
prosthesis. Not just because he can no longer function with the prosthesis
because it does not fit properly, but also due to the incontinent issues.
With the socket being made of leather and corset with a shoulder harness,
every time he has an accident, the excess gets soaked up in the materials of
the prosthesis and has become a major hygienic issue.
We discussed the possibility of fitting with a 1 piece thermoplastic socket
and using a Silesian belt for suspension. With a 2nd belt for easy
replacement for easy cleaning. We would be looking at a completely new leg
for obvious reasons, as I would not be able to work with the 50 year old
plus existing componentry. I just want to make sure I am going to get
reimbursed by Medicare.
TIA!
Jim Sedlak, CP
Prosthetic HealthCare Services
Citation
Jim Sedlak, “Medicare Reimbursement in a Skilled Nursing Facility?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237364.
