What is skilled nursing care? We’re glad you asked. There’s a whole page of information just waiting to be gleaned. Nursing homes usually take care of two type of nursing patients or residents. There are skilled residents and intermediate residents. Sometimes you may hear an insurance company or others refer to intermediate as “custodial” care. Skilled care comes from a definition used by Medicare, who usually pays for this service, or at least a portion of it.
The official definition of skilled service: skilled nursing and/or skilled rehabilitation services are those services, furnished pursuant to physician orders, that:
Require the skills of qualified technical or professional health personnel such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech pathologists or audiologists; and
Must be provided directly by or under the supervision of these skilled nursing or skilled rehabilitation personnel to assure the safety of the patient and to achieve the medically desired result.
Basically, skilled nursing services or skilled rehabilitations services are provided only by or under the supervision of professional or technical personnel. For Medicare to pay, not only do the services need to be considered skilled, but, they must be done on a daily basis. Because the rule is often subject to interpretation by both the nursing home and Medicare, it is important to come to an understanding prior to admittance or shortly thereafter. And if you believe the nursing home is wrong in their interpretation, and the resident is eligible for Medicare, you may request that they bill Medicare anyway and get a determination from them.
Most private insurance companies have the same definition of skilled care as Medicare.