Medicare and hospitals

[DDoug]

Some thing you should look at. If you go into the hospital for what ever and you are there as observation and when you are discharged and need a nursing home Medicare will not pay. If you were admitted and there for 3 days Medicare will pay. This is in the (new obamacare) rules so make the hospital admits you as a patient and your not there for observation. It could break you,hope no one gets caught on this

[TednRobin]

I am sorry to have to correct you on this one, this is a an old Medicare rule, you must have 3 night stay in hospital to qualify for the Skilled Nursing stay,(first 20 days covered at 100% should you qualify for the skilled need) then 21-100 days at at copay for the patient. Has nothing to do with ObamaCare.

Hospitals are using the Observation stay should the patient not meet criteria for the inpatient stay. And you are correct that Observation days do not apply toward the 3 night stay. When in Observation you may incur outpatient copays and may pay for maintainance drugs when in hospital. Depends on the hospital billing practices.

I do this for a living on a daily basis.

[gerryann]

I am sorry to have to correct you on this one, this is a an old Medicare rule, you must have 3 night stay in hospital to qualify for the Skilled Nursing stay,(first 20 days covered at 100% should you qualify for the skilled need) then 21-100 days at at copay for the patient. Has nothing to do with ObamaCare.

Hospitals are using the Observation stay should the patient not meet criteria for the inpatient stay. And you are correct that Observation days do not apply toward the 3 night stay. When in Observation you may incur outpatient copays and may pay for maintainance drugs when in hospital. Depends on the hospital billing practices.

I do this for a living on a daily basis.

Thanks for this info. Very important, and we should all be aware of this. Why does it have to be so darn complicated?

[TednRobin]

:welcome:

[StarbuckSammy]

TednRobin...thanks for the correct information. Amazing how so many people blame Obamacare...
We had the experience with my 90 year old mother who fell, was in the hospital for 3 days but was NOT "admitted"..she was there under "observation". Off to the nursing home for a 30 day rehab and she had to pay the $6,000 for the stay. Medicare did pay for the P/T.
It is very important to ask the nurse or someone if the patient has been "admitted".

[KathieI]

From what I remember, TedNRobin is (are?) correct. I experienced this with my 94 year old dad when he was ill. I worked very closely with the hospital advocate and the nursing home advocate to avoid our paying anything and they were extremely helpful. This was long before Obamacare.

[LatDoc]

Good info TedNRobin...thanks.
To add to the confusion...Humana Gold Plus...a medicare advantage plan...does not require a hospital stay to be covered in a SNF
Point is...tricky business..know your coverage or talk to a knowledgeable social worker.

[TednRobin]

Good info TedNRobin...thanks.
To add to the confusion...Humana Gold Plus...a medicare advantage plan...does not require a hospital stay to be covered in a SNF
Point is...tricky business..know your coverage or talk to a knowledgeable social worker.

Yes you are correct many Medicare Advantage plans have waived the 3 night rule, Medicare would be smart to do the same.

Always ask to speak with your case manager when you are hospitalized. If you have any thought you might need a SNF or Rehab stay on discharge, the facilities are usually running full, don't wait till the day of discharge to start the process.

Always be sure what status you were admtted under, OBS vs admit. Hospitals should be making you aware up front what your status is, some hospitals now have you sign a form that you were notified on admisson of your status. It is your right to know.

Happy to help. Robin

[Russ_Boston]

Just a POV from another TVRH nurse (me):

Our case managers don't let this fall though the cracks. They stay on top of the doctor to make sure the right admission status is placed. It has been my experience that if you need rehab of some sort we make sure you know your options, both medically and financially. We don't blind side anyone.

[TednRobin]

Just a POV from another TVRH nurse (me):

Our case managers don't let this fall though the cracks. They stay on top of the doctor to make sure the right admission status is placed. It has been my experience that if you need rehab of some sort we make sure you know your options, both medically and financially. We don't blind side anyone.

I whole heartedly agree with you Russ, having worked at TVRH as a Case Mgr, I know the hospital is right on top of it. Hope you like working at the hospital, Russ. I am back up north and miss everybody.