For residents in a Medicare Part A-covered stay, this service would be included as part of consolidated billing, meaning the facility is responsible for the cost of the services. Medicare Advantage, Medicare Part D Plans and other insurance providers may have other requirement before authorizing payment for services and the facility should refer to their contracts or the individual plans for guidance.

Medicaid PDPM can vary from state to state. For example, in Illinois, the Medicaid PDPM CMI uses the Nursing component case-mix group as the individual resident’s CMI score. As in Medicare PDPM, administration of IV fluids within the seven-day assessment reference date (ARD), in most cases, places the resident’s Nursing case-mix group into the Special Care High category. For those residents whose nursing GG function score is 15-16, the score would default to Clinically Complex. Facilities must review their state guidelines.

In most cases, administration of IV fluids within the seven-day assessment reference date (ARD) places the resident’s Nursing casemix group into the Special Care High category. For those residents whose nursing GG function score is 15-16, the score would default to Clinically Complex.

Medicaid CMI varies from state to state as well. In states that use a RUG-based system, either RUG-III or RUG-IV, variations exist in the groupers used. For example, NY uses a RUG-III 53-grouper in which IV fluids or medications place the resident in the Extensive Services case-mix group. At a minimum, the resident would score SE1. In this grouper, IV medication or fluids combined with skilled rehab services place the resident in a Rehab + Extensive Services category, at minimum RML. Mississippi uses a RUG-IV 48-grouper in which IV fluids score in the Special Care High case-mix group, and there is no additional reimbursement for residents who also receive skilled rehabilitation services. The case-mix group defaults to whichever score is higher.

The care plan should be updated to include an entry for dehydration or risk for dehydration and should consist of interventions in place when the problem is noted. When the decision is made to administer the IV fluid, the care plan should be updated to note that further intervention is needed and the reason for administering fluids intravenously. The care plan would also be updated to include the effectiveness of the intervention.

The infusion is a base of normal saline, which contains zero calories. Vitamins and additives are also calorie-free.