Hello. My father was admitted into the hospital on July 16th due to malnutrition and dehydration. He lost 40 lbs during COVID and a neighbor stopped by and found him in his home (he lives independently). He had oral cancer ~12 years ago and as a result has serious issues with swallowing. The doctors believed his swallow relapsed and suggested he go to therapy to receive PT, ST and OT. He also has a feeding tube to receive all of his nutrition because he was aspirating when eating/drinking.
He was transferred to the SNF on July 25 for treatment and on August 19th I was told his Medicare coverage would stop because he progressed in PT. They said his care was custodial. I appealed this because I believe he still needs ST and he is on a feeding tube receiving 100% of his nutrition. My appeals were denied and my husband and I are now paying for him to stay privately. But I am continuing to appeal since I think he’s entitled to the full 100 days of SNF care.
Here’s where things get complicated. My father is extremely confused (he believes he’s eating orally and he’s not so when the therapist comes in to work with him he doesn’t understand what’s going on). The psychiatrist believes this confusion is due to the encephalopathy diagnosis he received but as I am appealing to Medicare to cover these days that he is staying I want to set myself up for success.
He is receiving 100% of his nutrition via g tube and he is not of sound mind/fit to care for himself at home. He doesn’t recall the instructions to handle his tube safely and when he’s not being fed, he doesn’t even realize he has a feeding tube. He’s not of sound mind and I think he’s entitled to Medicare coverage for the full 100 days.
Do I have a case? How can I successfully appeal this? I am not taking my request directly to Medicare and providing all the documentation because I believe the facility only provided PT notes and not information on his mental status, feeding tube or ST.