My mom is in an SNF and they have sent me a form SNF Determination on Continued Stay along with a Request for Medicare Intermediary Review Form. She has used up her 100 days in the nursing home and recently qualified for Medicaid so that will now cover her NH costs. However, I am unsure how to complete the Medicare Review form - do I check the box that she wants her bill for services she continues to receive be submitted to the intermediary for a Medicare decision or do I check the second option that she does not want her bill for services to be submitted to the intermediary for a Medicare decision. It seems pretty clear that Medicare will not pick up any more charges since she is now on Medicaid. Any suggestions?
Medicaid reinbursement is much, much lower to the NH than Medicare would pay.
The NH I would think would prefer days 21 - 100 to be Medicare paid. Medicare rarely pays for all those days unless there are significant medical needs that need super skilled care. So if Medicare paid for day 21 - 100 for her, she is super lucky and her NH too.
Is this what happened.....your mom was in the hospital (Medicare and any other insurance like Blue Cross, paid for that) and got discharged from the hospital to a SNF/NH for "rehabilitation"; she has been in the SNF/NH for more than 20 days (Medicare and any other insurance paid 100% for this part of her stay too); and it is now apparent that she will not be able to return to her prior living situation and needs to stay in the SNF/NH and it is more than 100 days. Is this her story?
Most NH admissions come from a hospital discharge. If an individual covered by MediCARE is discharge from a hospital to a nursing home for continued care (rehabilitation) after an inpatient stay of at least 3 days, MediCARE will cover 100% of the first 20 days and MAY pay up to 100 days, subject to a co-payment by the patient of $141.50 per day for days 21 to 100 (for 2011) - this co-pay may be covered by other insurance like BC/BS. Medicare does not pay for the many months/years that some people reside in a NH for long-term custodial care. In general, Medicare is limited to short-term acute care.But this MediCARE paid period of time in the NH is when you need to get the documents together to apply for MedicAID. Which is what you & the NH did to get your mom on MedicAID.
I think what the paperwork is all about is the issue is who is going to pay for the days between day 20 and day 100. Will it be Medicare (and other health insurance) or Medicaid. Medicare pays a much, much higher rate and the SBF/NH would prefer that BUT they can't apply for payment for days 20 - 100, you or whomever is the DPOA/MPOA needs to do it. That is what that form is probably about but check with the social worker (not admissions) about it.
Also ask about how they handle the co-pay for days 20 - 100. If you or other family have to do the co-pay, this will be over 11K for 80 days. If your mom is on Medicaid, then she has no real assets to pay.
My mom went from IL to SNF/NH and this involved a whole other set of criteria to have her vetted as medically necessary and went through an Medicare appeals process. Nothing but fun and more fun. Timeframes and keeping documentation on who you spoke with and when are really important when dealing with the feds - if something needs to be done within 30 days it really needs to be received by day 20. So you need to be vigilant and try to keep a sense of humor too. Good luck.