Medicare and Skilled Nursing Facilities - What the heck is going on?

[@iHealthBrokers]

Skilled nursing facility care is NOT the same as long term or custodial care. If you have questions about your Medicare coverage, please feel free to ask in the comments!

[@RohitGupta-hi1lf]

can you please specify the difference between skilled nursing facility and hospice

[@iHealthBrokers]

Hospice is meant as palliative care (not curative) for a terminally ill patient. A skilled nursing facility is meant for short term recovery after someone is hospitalized for an injury or illness. Thanks for your question!

[@stev5vasanth]

Hello, We came across a scenario where a patient gets surgery in an ASC center. When we billed out the claim to Medicare, they denied it, saying, "The patient was enrolled in the SNF during the date of services." We reached SNF and submitted the bills, but after their review, SNF denied it, stating they only cover Medicare Part A services, and CPT, which we billed, is not found under Medicare Part A Service. Did anyone come across the scenario above? If so, how do you deal with it? Thank you!!

[@iHealthBrokers]

So sorry, medical billing isn't our specialty. Best of luck!

[@docimma]

Longterm care link mentioned?

[@iHealthBrokers]

Here you go! kzbin.info/www/bejne/fGTGp3iYfq91rKs

[@lizat.7989]

Hi i have question please why do Medicare pay to the patient

[@iHealthBrokers]

I'm sorry. I don't quite understand. Could you elaborate please? Medicare does not pay the patient, but would pay the facility directly. I hope that helps!

[@lizat.7989]

@@iHealthBrokers thank you for your reply i appreciate it in my study book it says patient can submit claim himself and get paid directly from medicare if the doctor dont submit on his behalf and also please can you make a video for acceptance of assignment i dont understand it at all and its my chapter

[@iHealthBrokers]

@@lizat.7989 So this really shouldn't be happening. If a doctor accepts Medicare, they should be filing the claim. That being said, if (for whatever reason) they don't, this link has the instructions to submit a claim. And thanks for the video suggestion! We'll add it to our list! www.medicare.gov/providers-services/claims-appeals-complaints/claims

[@jenscouponacct5048]

Hi. My mom was in short term rehab for a broken hip. She met her 20 days and stayed an extra week bc we were sorting out where her and my dad were going to live (he had to move to memory care). The night before she was to discharge from rehab she fell and was sent to the hospital where she stayed for 3 nights. She was then discharged to rehab again (we chose a different facility) but I was told since her 20 days were used, and her supplemental insurance didn’t pay for the facility (they only paid for the PT - she has Bc/BS), I’d have to pay out of pocket ($2300/week). I’m confused as to where the 20-100 day coverage comes in bc she’s within that window so why am i paying out of pocket. I’ve told them my goal is to get her rehabbed enough to be admitted to assigned living so they shouldn’t be billing as if long term care. What am I missing??

[@iHealthBrokers]

Does her plan cover coinsurance for SNF? Not all do!

[@rusteros2]

While at a SNF, is the patient financially responsible for doctors evaluating the patient? Do they have to pay copays for this?

[@iHealthBrokers]

Yes, those would fall under Part B. Great question!