Principles for Determining Skilled Services

 

  • If the inherent complexity of a service prescribed for a member is such that it can only be performed safely and/or effectively by, or under, the general supervision of skilled nursing, the service is a skilled service, e.g., the administration of intravenous feedings and intramuscular injections, the insertion of suprapubic catheters and ultrasound, shortwave or microwave therapy treatments.
  • MediGold considers the nature of the service, and the skills required for safe and effective delivery of that service, in deciding whether a service is a skilled service. While a member’s particular medical condition is a valid factor in deciding if skilled services are needed, a member’s diagnosis or prognosis should never be the sole factor in deciding that a service is not skilled.

           

 

Updated 01/2018