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Key Steps to Determine Medicare Part A Skilled Care

By Judi Kulus, NHA, RN, MAT, RAC-MT, DNS-CT, QCP - January 24, 2018

Many questions abound over what constitutes Medicare Part A skilled care. Can a resident be covered under Medicare Part A for non-daily, surgical wound care with intermittent suctioning and no therapy services involved? Can a clinician routinely add five days of nursing observation onto every Medicare A stay after therapy services end? Based on the limited information provided, neither of these scenarios meets the criteria for Medicare A skilled care, but why not? Clinicians need a methodical way to filter through the criteria to make individualized, accurate decisions about whether a resident qualifies for skilled care. 

When managing the traditional Medicare A program in a skilled nursing facility (SNF), your primary source of information is the Medicare Benefit Policy Manual (MBPM), chapter 8, “Coverage of Extended Care (SNF) Services Under Hospital Insurance.” It has some important information on how to determine whether a resident has met the requirements for accessing Medicare Part A skilled-level-of-care benefits.

Making coverage decisions can be difficult at times, but utilize the following steps and you will be well on your way to making solid Medicare A skilled care determinations.