Medicare And Skilled Nursing And Rehabilitation Cente
- Beneficiary must have a three day qualifying hospital stay.
- Admitted to the healthcare center within 30 days of a hospital discharge.
- Have unused Medicare Part A days.
- Have a diagnosis covered by Medicare.
You must receive the services from a Medicare certified skilled nursing facility. You are given 100 days of Medicare Part A coverage during a benefit period. The day you start receiving hospital or skilled nursing facility benefits is considered the first day of your benefit period. The first 20 Medicare days are paid 100% by Medicare Part A. Medicare will pay for all Medicare related charges during the last 80 days of your benefit period except for the co-insurance amount.
It is also important to note that you are not limited to a certain number of benefit periods, but you will need to have another three day hospital stay and continue to meet Medicare requirements in order to receive another 100 day Medicare benefit period.
A patient will remain on Medicare, Part A as long as it is medically necessary. If at any point during the patients stay their health improves and their diagnosis no longer supports Medicare coverage, they will either be discharged or change payor types.
The beneficiary must go 60 consecutive days without receiving skilled care. After the sixty day period, the beneficiary qualifies for another 100 days of care if they meet the pre-mentioned criteria.
Co-insurance is also referred to as percentage participation. When your initial 20 days are up under Medicare, your co-insurance will help you to pay for the services you are receiving that are not being covered through Medicare. There are typically three sources of co-insurance:
- Private Insurance Company
- The Patient
The patient is ultimately responsible for payment of co-insurance.
Medicare Part B pays for the following services when the patient is no longer covered by Medicare Part A:
- Physical Therapy
- Speech Therapy
- Occupational Therapy
Additionally, Medicare Part B covers a number of medical services not covered by Part A, if they are medically necessary. There is a 20% co-insurance amount for which Medicare Part B does not pay.