“Need for skilled care” is the Medicare standard for rehab payment
We are seeing an uptick in the number of fragile elderly patients whose post-hospital subacute Medicare benefits are being prematurely terminated due to lack of improvement. Before 2013, the insurance companies that were processing the post-hospital skilled care benefits under Medicare Part A were often using a “rule of thumb” whereby they would terminate benefits if the patient...
Watch out for “observation status” if patient will need skilled care after discharge
If you’ve been an advocate for a person who enters the hospital for treatment and then is discharged to a nursing home several days later, you know that after a three-day hospital admission, Medicare Part A can pay for up to 100 days of skilled nursing and physical/occupational/other therapy in a subacute or rehabilitation facility, provided that the patient requires that level of...
Baby Boomers looking ahead: long term care insurance or Medicaid?
There’s no doubt about it, long-term care insurance is expensive, and the premiums can be steep if you wait until after age 70 to first buy a policy. Some companies have gotten approvals for big premium increases on old policies. The marketplace has shrunk as companies have left the business, and some companies create bureaucratic barriers to paying claims. However, there’s also no...
Despite the JIMMO settlement, Medicare benefits are being prematurely terminated
Back in January 2013 the Centers for Medicare and Medicaid Services (CMS) settled a class action lawsuit called Jimmo v Sebelius concerning premature cutoffs of skilled care benefits under Medicare Part A. The problem was that patients in skilled care facilities after hospitalizations, who were placed there for skilled nursing and rehabilitation, were finding that their benefits were being cut...