Rehab Stays Not Covered by Medicare?
Posted By Maryann Porosky On JANUARY 07,2016
Cheryl received a call from the neighbor that mom had a fall while they were out shopping together. Mom was taken to the hospital. During her three days at the hospital, Cheryl read online that she’s entitled to a short rehab stay at a nursing home for physical therapy. When it was time for discharge, Medicare wouldn’t pay for the rehab stay, even though her mom could have benefited from rehab care. How did this happen?
A patient can be treated at the hospital as an outpatient under observation status or admitted as an inpatient. It matters not how many procedures, such as CAT scans are performed. In this case Cheryl’s mom was in the emergency department being tested and treated for 36 hours. This period of time is outpatient time. Medicare doesn’t pay for covered nursing home rehab time because in this case, she didn’t meet the 3 day minimum of hospital inpatient time.
Medicare coverage is different depending on the hospital status – inpatient versus outpatient under observation.
Medicare pays for up to 100 days of rehab care in a nursing home with days 21 to 100 requiring recipients to make a coinsurance payment. That payment will be $161 per day in 2016, up from $157.50. The co-payment for days 61 to 90 of a hospital stay will increase from $315 per day to $322 per day and for days 91 and beyond it will go from $630 per day to $644 per day. For Medicare Advantage enrollees the average premium will decrease slightly from $32.91 to $32.60 in 2016.