HH_GuideForFamilies_2012 - page 35

A Guide for Residents & Families at the Hebrew Home
The process
Before admission, a specially trained nurse
assesses each resident who has a Medicare
number to determine if that resident will
be eligible for Medicare benefits.
After admission, you and your family will
have an opportunity to confer about the
initial assessment and an estimate of how
long Medicare is likely to cover your stay.
As your capabilities improve, your care
team will adjust your goals, the frequency
and duration of therapy sessions, and
the estimate of the duration of Medicare
While Medicare will cover up to the first
20 days of an approved stay, you are
responsible for paying the current
Medicare co-pay amount for days 21-100
of each benefit period.
Remember that you must meet the criteria
for each day, and there is no guarantee of
the number of days of coverage.
When you no longer meet criteria for
Medicare coverage
The federal government requires (1) you
receive a notice of Medicare non-coverage,
and (2) you sign a letter acknowledging you
have received this notice. This letter will
describe your rights. A Hebrew Home staff
person will contact you at the appropriate
time about signing this letter. If you have
questions about this federal requirement,
please speak with your case manager or
utilization review nurse.
Benefit periods
A benefit period begins the day you go to
a hospital or skilled nursing facility. The
benefit period ends when you haven’t
received any hospital care or skilled care
in the nursing home for 60 days in a row.
After a benefit period ends, if you go to the
hospital again, a new benefit period begins.
You must pay the inpatient hospital
deductible for each benefit period. There
is no limit to the number of benefit periods
you can have.
Next steps
When the Hebrew Home contacts you
about Medicare benefits ending, you have
the option of returning to the community
or staying at the Hebrew Home on a
non-Medicare covered basis.
If you choose to stay, your social worker
will help explain the payor sources available
to you. Even when Medicare does not pay
the daily fee for care, Part B will pay for
physician visits, therapy, hospital stays, lab
tests and x-rays at 80 percent, and Part D
can help with prescription drug costs.
Many rehabilitation patients do return to
the community, and the case manager
will help to plan the discharge and to
make arrangements for recommended
care and services.
More information
for more
information about Medicare.
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