When a loved one is discharged from a hospital but still requires professional medical assistance, the hospital discharge consultant may recommend transitioning to a rehabilitative environment for a short period of time. This could be a few weeks to a few months. There are several financial factors to consider before a caregiver can make this decision.
Beware of Observation Status
To be eligible for Medicare coverage in a rehab setting, the patient has to have been in the hospital for three days, not counting the day of discharge and Medicare does not count being “under observation” as part of the three-day requirement. Observation status occurs when a patient comes to the Emergency Department and the doctors feel that the person is not sick enough to be admitted as an inpatient, but they are not sure whether the patient is well enough to go home. The patient may be sent to a regular floor even if they are not admitted but considered under observation. In this case the hospital bill for the patient may be higher than if he or she were actually admitted.
Additional Medicare Requirements:
- A doctor must certify that the patient needs skilled nursing care 7 days a week or skilled rehab services 5 days per week.
- The admission into the rehab center must be for the same condition, illness or injury that caused the need for the initial hospital stay.
- The timing must be in a certain benefits window. This benefit period begins on the first day of hospital admission (not observation status) and continues for 100 days. It ends when the patient has not received any services from the hospital or rehab provider for 60 consecutive days. The inpatient deductible must be paid for each benefit period.
- If these requirements are met, Medicare pays the full cost for the first 20 days and a portion of the cost for the next 80 days.
Private Health Insurance
Most health insurance plans follow the same guidelines as Medicare. Some require more frequent assessments and reporting. The financial department at the rehab center should be able to contact the insurance provider and ensure that all requirements are met to ensure proper coverage.
Planning for Discharge from the Rehab Center
There are several options for discharge from the rehab center:
- If the patient has regained independence and made significant improvement, he or she may be discharged outright with no additional services or occasional outpatient services.
- The patient may be discharged home with recommendations for in-home care.
- The patient may be discharged into a long-term care facility.
Do not remove a patient from a rehab facility without a proper discharge. The discharge plan may require that new equipment be purchased for on-going safety and improvement such as wheelchairs, hospital beds or monitoring equipment. These items are known as Durable Medical Equipment and paying for them may require some proactive planning.
If you do not feel comfortable with a discharge plan, you have the right to appeal the decision. For assistance with an appeal, creating a long-term care plan or preparing estate planning documents, contact the experienced elder law attorneys at Stouffer Legal in the Greater Baltimore area. You can schedule an appointment by calling us at (443) 470-3599, emailing us at office@stoufferlegal.com, or register for an upcoming free webinar using the link below:
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