Accreditation The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation Statement: The American Medical Directors Association designates this Internet Enduring Material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AMDCP Credit Designation: This session has been approved for a total of management 1.0 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).
Session Description: In the nursing home vernacular, making the determination that a patient qualifies for post-acute skilled services in a nursing home setting is known as “skilling.” It is the responsibility of the attending physician to provide orders that necessitate skilled services and to certify their medical necessity. This session will help the attending physician and medical director to understand the regulations governing skilled services in the skilled nursing facility (SNF) and how patients qualify for post-acute care in the nursing home. In addition to discussing regulatory requirements, this session will discuss the role of the attending physician in determining medical necessity for skilled rehabilitation and nursing services and how best to appropriately document and certify these services. The presenter will also cover the role of the physician in termination of services and the appeals process. This session will be relevant to any physician or medical director who attends or oversees sub-acute SNF patients.
Explain the regulatory requirements for the skilled nursing facility (SNF) level of care, differentiating custodial from skilled care.
Describe the role of the attending physician and medical director in certifying and determining skilled nursing facility (SNF) level of care.
Discuss the role of the attending physician and medical director in documentation and orders regarding skilled nursing facility (SNF) level of care.
Describe the role of the attending physician and medical director in termination of skilled nursing facility (SNF) services and subsequent appeals.
Speaker(s): Robert A. Zorowitz, MD, MBA, CMD
Disclosure(s): Dr. Zorowitz works for Optum, Inc., a division of UnitedHealth Group, which provides skilled nursing facility benefits in many of its health plans.
Reference(s): Center for Medicare and Medicaid Services. n.d. Medicare Benefit Policy Manual. Chapter 8 - Coverage of Extended Care (SNF) Services Under Hospital Insurance. Downloaded June 23, 2013 from www.cms.gov/Regulations-and-Guidance-Guidance/Manuals/downloads/bp102c08.pdf Code of Federal Regulations. n.d. Title 42 - Public Health. Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services. Subchapter B - Medicare Program. Part 409 - Hospital Insurance Benefits. Subpart D - Requirements for Coverage of Posthospital SNF Care. §409.30-409.36 Medicare Payment Advisory Commission. March 2013. Report to the Congress: Medicare Payment Policy. Chapter 8 - Skilled Nursing Facility Services, p. 157-183. Downloaded June 23, 2013 from www.medpac.gov/documents/Mar13_EntireReport.pdf