In order to qualify for Medicare Part A benefits in a nursing home, you must meet criteria for coverage, as specified by Medicare.
1. You must be an in-patient (full admit, not observation) in a hospital for at least (3) midnights, within 30 days of your nursing home admission.
2. Your condition must require the skilled services of a licensed nurse or therapist (physical, speech, occupational) on a daily basis.
If these criteria are met, you will be placed in a Medicare certified room and the facility will bill Medicare Part A for your stay as long as your condition continues to meet the criteria of Medicare's guidelines.
1. The first 20 days, Medicare pays 100% of the charges. If you have used any days in another nursing home or extended care of a hospital, this will go toward your days in our facility.
2. Days 21-100 Medicare pays everything except a co-pay of 20%. If you have a Medicare supplemental insurance, we will submit your claim for reimbursement. If your supplemental insurance declines payment, the resident will be responsible for the co-pays. If you are a Medicaid recipient, there will be no-copay.
The facility will contact the insurance company to verify benefits. The resident or responsible party can also contact the insurance company to confirm coverage.
The Medicare team will review your case weekly. When the resident progresses to their fullest rehabilitation potential or the resident no longer requires skilled nursing service on a daily basis, he/she will no longer qualify for Medicare Coverage.
If you have a Medicare Replacement policy, the facility will contact them to get an authorization number and to check on benefits. If the insurance does not cover your stay in the nursing home the resident will be responsible for payment.
The resident or responsible party can contact the insurance company to confirm benefits.