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Hospital Status Affects Medicare Nursing Home Coverage

Managing the financial details of entering and staying in a nursing home can be complicated and confusing for many potential residents. The consideration of whether Medicare will cover a nursing home stay depends on the official status that a patient receives at a hospital before being moved to the nursing facility, according to the Washington Post.

Specifically, Medicare will typically only cover a follow-up stay at a nursing home if an individual has three consecutive days of hospitalization as an inpatient. It will then pay for up to 100 days of rehabilitation or skilled nursing care. An inpatient is distinct from being labeled as an observation patient-where doctors are simply providing watch over a patient to ensure no complications or problems develop. When considering post-hospital care options, it is important to know that official label. A single patient can be switched from inpatient to observation patient, but the doctor is required to notify you if that change occurs.

It is not possible to appeal the official hospital determination of your status, regardless of whether or not you feel that you will need nursing home care following the hospitalization. Some suggest calling your personal physicians and asking him or her to talk to the hospital on your behalf regarding your patient label if you strongly believe that you should be considered an inpatient instead of at the hospital for observation only.

If that option does not work, it is still possible to enroll at a nursing home and ask Medicare to be billed. The request will likely be denied, but that can be appealed. However, if those appeals are not accepted, the individual patient will be responsible for the charges.

Our Chicago nursing home attorneys at Levin & Perconti understand that finances are one of many concerns that potential residents and their families have when deciding how to provide necessary care following hospitalizations. While figuring out the cost of nursing home stays, it is incredibly important to also consider the quality of the facility that may be used. Our lawyers have seen first-hand the devastation caused by bad nursing homes that do not take resident heath, safety, and dignity seriously. There is extreme disparity in the quality of care provided at some nursing homes as opposed to others. It is vital to understand the quality of these facilities before making a final decision.