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

Jan 1, 2019

  1. Northeast Agent
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    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?
     
  2. Rob Lion
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    Look at the plan and see what nursing homes are covered under the plan. Most nursing homes have skilled nursing.
     
  3. Northeast Agent
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    Medicare doesn't usually cover nursing homes. And I don't understand why she didn't get the MOON notice, like you're supposed to.
     
  4. gregj
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    gregj Super Genius

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    doesn't at all, but does cover care by nursing homes certified to provide SNF services - of which many are nursing homes, as Rob tried to tell you.
     
    gregj, Jan 2, 2019
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  5. Northeast Agent
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    Gregj, OK thanks that makes sense. But what about her not receiving the MOON notice?
     
  6. gregj
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    gregj Super Genius

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    I'm with you -- that seems odd. Is there any other way for you to get confirmation, or to inquire of the facility whether they did supply it?
     
    gregj, Jan 3, 2019
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