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  1. #1
    Join Date
    Aug 2008
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    27

    Default Medicare Eligiblility for a Skilled Nursing Facility

    How much responsibilty does a skilled nursing facility have in determining medicare elegibilty? My mother was admitted into a skilled nursing facility as a medicare patient. The admissions person checked out her medical record and assured us that her stay would be covered by medicare. We fronted no money and all the forms indicated medicare would be billed for the stay.
    Now we recieve a bill from this facility saying medicare denied the claim because only 54 days had past since her last stay in an acute care facility not the required 60. I feel that the admissions person should have done a better job of qualifying my mother before admitting her as a medicare patient.

  2. #2
    Join Date
    Sep 2005
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    Default Re: Medicare Eligiblility for a Skilled Nursing Facility

    What would you have done differently had they known about the prior stay and told you that she wouldn't qualify for Medicare? How would they have known about the prior stay at the time of admission - did you or somebody else inform them of the prior stay and dates?

  3. #3
    Join Date
    Aug 2008
    Posts
    27

    Default Re: Medicare Eligiblility for a Skilled Nursing Facility

    She was entered for physical therapy I believe if we had known of the huge bill we would be facing we would have not entered her in the facility.
    The admissions person was very aware of my mother's history of prior stays and the days between stays. She also verifed it through the billing dept.
    The error, I believe, was that the admissions person thought that the applicant needed a 60 day period from the last facility. In the letter this facility sent me the reason for denial was that my mother need 60 WELL DAYS..that is, 60 days without being in any facility including hospitals. Whe was in a hospital during this 60 day period which led to her admission in this facility. The billing person had it straight, the admissions person didnt. I have since checked with medicare and the 60 well days is correct. So we missed the cutoff by 4 days. Had we known and waited another 4 days all would fine.

  4. #4
    Join Date
    Jun 2009
    Posts
    7

    Default Re: Medicare Eligiblility for a Skilled Nursing Facility

    Quote Quoting stinut
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    How much responsibilty does a skilled nursing facility have in determining medicare elegibilty? My mother was admitted into a skilled nursing facility as a medicare patient. The admissions person checked out her medical record and assured us that her stay would be covered by medicare. We fronted no money and all the forms indicated medicare would be billed for the stay.
    Now we recieve a bill from this facility saying medicare denied the claim because only 54 days had past since her last stay in an acute care facility not the required 60. I feel that the admissions person should have done a better job of qualifying my mother before admitting her as a medicare patient.
    In the perfect world this would not have happened. The admission person should have caught this. Normally billing would get involved prior to admission, so another check for this not to happen. It's true has to be 60 well days. That's 60 days without a skilling service. That could include outpatient PT, OT. I would talk to the administor and see what they can do. See if they can do a medcaid skilled. They are more than likely billing for the therapy and that's where the big money bill is.

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