Am I an inpatient or outpatient? Page 28 2019 Medicare & You

Northeast Agent

Guru
1000 Post Club
2,053
Pennsylvania
A friend of my mother's who is on Medicare (not my client), recently suffered her fourth stroke. She's a heavy smoker and diabetic.

She has a MA plan and was sent home after six days in the hospital. Said she was told she could go home with nurses and PT or be sent to a nursing home (the plan would pay), but NOT to a SNF.

I don't understand why the plan supposedly would pay for a nursing home?

I asked my mother to see if she received a "Medicare Outpatient Observation Notice" (MOON). The friend said she didn't. Is this something she can file a grievance about against the hospital?
 
What they told her and what she understands and relates to you may not be the same thing. LTAC is like SNF but more intensive and expensive. Most MAs only cover LTAC in extreme circumstances. SNF is typically done at a nursing home. Medicare (and all MA I’ve heard of) only cover nursing home in the event of SNF. She probably could have been covered for a SNF nursing home but not an LTAC facility. She probably misunderstood.
 
Blah.

1. Under Observation is a PITA, but it only applies to Original Medicare. And there's not a SNF in the United States who isn't checking Under Observation vs Inpatient before they agree to the transfer

2. SNF and Nursing Home are usually the same thing, because of the services provided.

3. LTAC is not going be an issue after 6 days in the hospital. LTAC is typically used after 30 days in the hospital and its not for post-stroke.

4. Agree with Stephanie, client is confused

And THIS ladies and gentleman, is just another example of why MA sucks. It may be great when you are in your 60's, but 80+ and confused, its a disaster.
 
Blah.

1. Under Observation is a PITA, but it only applies to Original Medicare. And there's not a SNF in the United States who isn't checking Under Observation vs Inpatient before they agree to the transfer

2. SNF and Nursing Home are usually the same thing, because of the services provided.

3. LTAC is not going be an issue after 6 days in the hospital. LTAC is typically used after 30 days in the hospital and its not for post-stroke.

4. Agree with Stephanie, client is confused

And THIS ladies and gentleman, is just another example of why MA sucks. It may be great when you are in your 60's, but 80+ and confused, its a disaster.
I would disagree with #2... SNF is Skilled Nursing Facility in which Medicare may pay. Nursing Home could be Intermediate or Custodial Care facility in which Medicare will not pay..
 
Back
Top