For those of you who have gone to the Emergency Room (ER) or taken your parent to the ER for treatment after a fall or episode, this is important information, especially if you or your loved one is on Medicare.
There is a lot of misinformation or partial information floating around about whether Medicare pays for a stay in a Nursing Home for rehabilitation. Medicare will pay for the first 20 days in a Skilled Nursing Facility if you are transferred there from a hospital after being admitted for three days. There is also a requirement that you show improvement at the facility for Medicare to pay.
The three day requirement can lead to confusion and misunderstanding about who pays for the care. Sometimes patients are in a hospital room after going to the Emergency Department receiving meals and they think they are actually admitted to the hospital, when in fact they are only under observation. It is important that you ask the hospital staff if you are actually admitted to make sure the three day requirement is met. Currently the hospital has no obligation to notify you of this status.
Senate Bill 0195 proposes to require a hospital, under specified circumstances, to provide notice to a patient of the patient’s “outpatient” status, the billing implications of the outpatient status, and the impact of the outpatient status on the patient’s eligibility for Medicare rehabilitation services; and to also require the Department of Health and Mental Hygiene to adopt by regulation standard language for a specified written notice.
This is a serious problem with our current system and we hope this legislation will address these issues. If you don’t have to pay for the first 20 days, that is more money in your pocket.
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