April 25, 2017

Understanding Medicare Coverage for a Rehab Stay at a Skilled Nursing Facility

Not surprisingly, many rehab patients are confused about Medicare coverage after they leave the hospital and are admitted to a skilled nursing facility. The guidelines for Medicare coverage, set by the Center for Medicare Services (CMS), are extremely regulated in terms of rehab stays. Many people assume they are automatically eligible for 100 Medicare days; however, this is not always the case.

After a patient is admitted and settled into our facility, they are immediately assessed by our rehab department. We check to see what their needs are and what disciplines of therapy will be required for their recovery. The rehab disciplines we offer at the Leonard Florence Center for Living include physical, occupational, and speech and language pathology. The next step in the process involves an assessment performed by the nursing department. This will help determine what medical conditions are associated with the rehab stay. From this point forward, the rehab team can begin their work with the patient. Note that as long as the patient is making positive gains during their rehab stay, Medicare will cover the cost of the rehab stay.

At the Leonard Florence Center for Living, our staff meets regularly to discuss the patient’s situation, their positive gains, and how long the patient will need to rehab at our facility before being safely discharged to home. The average length of a stay is approximately 2 ½ weeks, but this varies significantly from individual to individual. Keep in mind that as long as the patient is making positive gains, he or she is eligible for Medicare benefits.

The good news: The majority of rehab patients are discharged within a reasonable time. Upon their discharge, they will once again be eligible for their full benefit of 100 days if they have no further hospitalizations for 60 days.

An explanation of Medicare benefits is available in the Medicare Book provided annually by CMS, or on the Medicare website: https://www.medicare.gov. The best strategy for determining one’s Medicare benefits is to keep asking questions. There’s no such thing as having too much information on this subject!

This blog is courtesy of Ina Hoffman, Admissions Director at the Leonard Florence Center for Living in Chelsea, Massachusetts.