Medicare 3 Day Rule

[Insuranceman]

I've got a call from a client that was informed by the nurse that Medicare is getting strict on keeping patients no longer than 3 days so Medicare won't have to pay nursing home.

Another client call about her mother who was in the hospital for 5 days but Medicare refused to pay for nursing home because she was just under observation while she was in the hospital.

Is this the future of Medicare coverage?

 

[Chazm]

I thought "rehab" was always only for medicare approved reasons.

Atleast thats what i always tell clients.

 

[VaDwayne]

I've got a call from a client that was informed by the nurse that Medicare is getting strict on keeping patients no longer than 3 days so Medicare won't have to pay nursing home.

Another client call about her mother who was in the hospital for 5 days but Medicare refused to pay for nursing home because she was just under observation while she was in the hospital.

Is this the future of Medicare coverage?

Normal procedure as Medicare does not pay for nursing home care, just skilled care. If she is only being observed, it would not be medically necessary that she be in skilled care. She also needs to be showing signs of improvement for skilled nursing care, so if she is only being observed, she is probably not getting any worse OR any better which means she doesn't qualify.

 

[moonlightandmargaritas]

Is this the future of Medicare coverage?

I hope so. How much longer can we expect taxpayers to pay for this gravy train? If we had unlimited resources, we could pull out all the stops to make sure our seniors get "no holds barred" care.

Problem is; we're broke and can't afford it. We don't have unlimited resources.

 

[briko3]

The main reason for LTC is the above. How many people with alzheimers do you know that are improving? Maybe that 180 day waiting period isn't a good idea after all?

 

[Josh]

I was under the impression that Medicare would only pay for if the beneficiary had been in the hospital for at least 3 days, not the other way around.
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Problem is; we're broke and can't afford it. We don't have unlimited resources.

Amen! .

 

[VaDwayne]

I was under the impression that Medicare would only pay for if the beneficiary had been in the hospital for at least 3 days, not the other way around.
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That is correct sir, but you must require care from a doctor, or an R.N, etc. for Medicare to pay.

 

[Josh]

That is correct sir, but you must require care from a doctor, or an R.N, etc. for Medicare to pay.

I didn't think I was losing my touch with random Medicare trivia!