Part A - Skilled Nursing Facility

[Mack]

Part A includes skilled nursing facility care which includes room (semi-private), meals, and skilled nursing and rehabilitive services.

A 3 day minimum hospital inpatient stay is required prior to beginning care at the skilled nursing facility. Of course a doctor's orders are required, certifying that you need skilled care. This is not to be confused with long term care, which Medicare does not cover.

 

[Avidmaster]

My question is my father went through the 4 day stay at the hospital and then was put into a skilled Nursing facility to get better. He has received therapy but all of a sudden I receive a call that his medicare will no longer cover his stay because they can do no more, which I disagree, and in two days coverage ends. I thought they had to give at least a 10 day notice to end Medicare so if you want to appeal you can prepare. He was given 2 days and by phone. Can someone help me with what the time frame is for notice of no longer getting service? Thanks.

 

[Avidmaster]

Part A includes skilled nursing facility care which includes room (semi-private), meals, and skilled nursing and rehabilitive services.

A 3 day minimum hospital inpatient stay is required prior to beginning care at the skilled nursing facility. Of course a doctor's orders are required, certifying that you need skilled care. This is not to be confused with long term care, which Medicare does not cover.

Thanks for response. He was in the hospital for 4 days originally. Then the day they said coverage was no longer necessary, we appealed and lost. Easy to understand looking at the forms they send in and my 3 minute recorded conversation, to weigh out a decision. Ironically, he was unresponsive the next day at the SNF and they took him to the hospital where he stayed another 3 days. during that stay, the PT and doctor both agreed he needed more PT and recommended it on their reports. We went back to the SNF and the next day they had a meeting and determined at the SNF he no longer needed PT! I was totally confused, after one session doesn't need it anymore? All the while, he went in walking on his own, no help and clear with thought. I thought the idea was to get him in SNF back to the way he used to be andf then release?
On top of all this he is very hard of hearing. I find out the doctor at the SNF could have wrote a prescription to request and audio device, they did use with him at one point with great success, but never did. Only had one at the facility. Any communication with him without this devise is useless but on the reports it states confused when asking questions. My thought is the SNF wanted to get him into their long term nursing facility where they make more money and have less people on staff. Appealed this time again and stated all the facts in black and white rather then phone call. Got them the info yesterday and get a call today saying denied. They said doctors reviewed the info and said no. How can they review all of this in such a short period? I got copies of the info sent by SNF and half of it I cannot even read not that it is in Doctor jargon but basically not able to read it because so jibberish. I would guess Maximus Federal must turn down most of the appeals just to cut costs. Anyway, interested in your opinion and I am taking to a higher court.

 

[johtootie]

My question is my father went through the 4 day stay at the hospital and then was put into a skilled Nursing facility to get better. He has received therapy but all of a sudden I receive a call that his medicare will no longer cover his stay because they can do no more, which I disagree, and in two days coverage ends. I thought they had to give at least a 10 day notice to end Medicare so if you want to appeal you can prepare. He was given 2 days and by phone. Can someone help me with what the time frame is for notice of no longer getting service? Thanks.

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After reading your post, I couldn't help but reply about your experience. If your dad has Medicare Part A, they will pay at 100% for 20 days. After 20 days, Medicare Part A pays at 80% and the patient is responsible for the 20% (co-pay) unless they have a supplemental insurance, which will cover the copay. The patient is allowed up to 100 days as long as progress is being made with therapy services. This is something that should've been discussed with you by the facility's business manager at admission. With that being said....therapy is used to what they call "skill" a patient when they are admitted to a SNF for rehab purposes. ("Skill" just means that therapy (physical therapy, occupational therapy, and/or speech therapy) are providing a professional service or intervention technique to that resident that requires a particular knowledge base.) The resident has to make gains or progress in order for Medicare Part A to continue to pay for services. From my understanding, Medicare will only pay 2 weeks of documented "non-progress". However, out of courtesy there should've been more notification to allow you guys to make proper arrangements or explore another resource. Also was he receiving speech therapy services or occupational therapy services, because they could've trained him on an assistive listening device that was appropriate for him. I am so sorry that you had this experience and hopefully this will not taint your views about the therapy profession.

My question is my father went through the 4 day stay at the hospital and then was put into a skilled Nursing facility to get better. He has received therapy but all of a sudden I receive a call that his medicare will no longer cover his stay because they can do no more, which I disagree, and in two days coverage ends. I thought they had to give at least a 10 day notice to end Medicare so if you want to appeal you can prepare. He was given 2 days and by phone. Can someone help me with what the time frame is for notice of no longer getting service? Thanks.

 

[kwilburn]

Part A includes skilled nursing facility care which includes room (semi-private), meals, and skilled nursing and rehabilitive services.

A 3 day minimum hospital inpatient stay is required prior to beginning care at the skilled nursing facility. Of course a doctor's orders are required, certifying that you need skilled care. This is not to be confused with long term care, which Medicare does not cover.

I have a hospital inpatient that was in our facility for 2 nights and then transferred to another acute care facility for 2 additional nights for a higher level of care. She was then transferred back to our swingbed unit. Our unit was told that we could use both hospital stays to qualify for the 3 day qualifying stay. The patient had a total of 4 qualifying days, how do I report?

 

[Mack]

Part A includes skilled nursing facility care which includes room (semi-private), meals, and skilled nursing and rehabilitive services.

A 3 day minimum hospital inpatient stay is required prior to beginning care at the skilled nursing facility. Of course a doctor's orders are required, certifying that you need skilled care. This is not to be confused with long term care, which Medicare does not cover.

I have a hospital inpatient that was in our facility for 2 nights and then transferred to another acute care facility for 2 additional nights for a higher level of care. She was then transferred back to our swingbed unit. Our unit was told that we could use both hospital stays to qualify for the 3 day qualifying stay. The patient had a total of 4 qualifying days, how do I report?

Your question is beyond me. You should contact Medicare about it.