How does it work? Medicare and Medicaid formularies influence your discharge plan For insurance to pay for an acute care hospital stay, a post-acute care facility or a long-term care facility, there must be a “skillable” need. (e.g. Care requiring the skill of a licensed physician, nurse, physical and/or occupational therapist.) It can't be over stated that Medicare only … [Read more...]
Hospital Discharge – How Does It Work?
What does a hospital discharge planning team do? Every hospital has a discharge planning team made up of nurse care managers and social workers. Physical Therapists, Occupational Therapists, Registered Nurses and Pharmacists are brought in as needed. This team is responsible for the documentation that proves you require the care/treatments given by licensed nurses or … [Read more...]
Rehabilitation after Surgery, Stroke or Hospital Stay
What happens if you still need help after a hospital stay? It is common to need help to regain strength, manage a chronic illness, or re-learn activities of daily living after a hospital stay. But who determines what type of rehabilitation is needed? Who determines if help at home or in a facility is best? What are the criteria for release to a rehabilitation facility as set … [Read more...]
Hospice, How Does This Business Work?
How Can Agencies Differ? Hospice programs are performed by licensed hospice agencies. Hospice agencies follow Medicare criteria for patient eligibility; however, each agency has some flexibility in facilitating their services. For example, a hospice agency may provide aide service on weekends. Hospices generally have some relationship with local hospitals and elder care … [Read more...]
Hospice, Who Pays for It?
Medicare is the Number One Payee for Hospice Care. Insurers that pay for Hospice care include: Medicare, Long Term Care Insurance, Private Pay, and in certain circumstances, Medicaid will pay for hospice. Here is the breakdown of insurers: (Jump to Lessons Learned) Medicare Over 90% of all hospice cases are covered by the Medicare Hospice Benefit under Medicare Part A. … [Read more...]