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You can pay week-to-week though.
You'll have to request a written bill though. Care facilities don't like to do this because they bill by the month and sometimes a month ahead. This means if they get paid up and the person is only there for a week, they keep the money.
Request to be billed weekly.
I pray that you are doing okay and that you have received grieving mercies and comfort during this difficult situation.
If your mom doesn't qualify for inpatient therapy but could be eligible for outpatient, I'm wondering if you folks could do something similar--have her self pay for the room and board portion of the charges and have the facility bill Medicare for her therapies (PT, OT, etc.) as outpatient. On the other hand, if she truly isn't going to make enough progress to meet the goal of returning home, it's probably not worth spending the money.
I found that I had to be proactive in getting my dad more care paid for by his Medicare. Speak with the facility and find out if she is making daily progress and how she can remain until she can do certain things.
If she can not safely come home if she isn't mobile, that could mean that she has now bypassed your ability to care for her in your home. You can't risk your wellbeing trying to get her in and up and dressed if she can't do it.
Unfortunately our loved ones can fail pretty quickly at her age and changes happen overnight. Please don't feel bad if her care is now more than you can handle safely. You will still be her advocate and most importantly, you will be able to be her daughter again.
Will you come back and let us know how you worked it out? We learn from each other and your contribution is valuable. Thanx! HUGS!
Is it 20% or 50% that MediCARE will pay from day 21 - day 100 for in a facility post hospitalization rehab for 2021???
And is the $185 set rate for the day 21+ copay only if you r Original MediCARE & a gap?
But if your Advantage, it will totally depend on the wording in your specific Advantage plan; so Advantage may or may not have a fixed $185 copay.
&
has anyone gotten an Advantage plan that actually has a residential rehab facility that is “in network”? Not a rehab place that you go to & spend better part of a day getting rehab, but one that you can stay in for week or 10 days or so for rehab.
Thanks in advance for insights. Yeah I know it should be a discussion but it dies relate to this post.
*the patient has to be participating in rehab
*the therapist and doctor have declared that the patient is progressing and will need rehab to continue to improve.
Once the patient plateaus or stops participating all insurances will stop paying. At that point if Mom wants to continue rehab and has the funds she can definitely pay for the service. You can always call Medicare or your Medicare Advantage program to see if they have a separate coverage for in home rehab. I'm not sure how that works.
This is what 97yroldmom is referring to & pls read the link she posted.
Basically the issue is that once they are notated in their chart by the therapists after 2-3/5 subsequent sessions as “not progressing” then Medicare will stop paying & the doctors orders for doing therapy will cancel. Medicare can pay up to 100 days for therapy as long as they are still progressing. The 20 day period at the beginning has Medicare paying 100%. But if they still need rehab beyond the 20, Medicare will pay but at 80% with the 20% either from their secondary insurer or private pay. But they have to have orders from a MD for the therapists to base a care plan on.
I’d suggest that you ASAP have a clear chat with the therapists - PT, OT, ST - and find out exactly where your family member is in their therapy plan and if still progressing. What usually happens is they get discharged from the hospital with a specific ICD code for their therapy plan. So maybe knee surgery has 24 sessions and measurements done every other session which is recorded in their chart and reported to MediCARE. If their chart is showing no progress, it’s going to be hard to disprove. And the insurers are not going to pay. You as dPOA can appeal MediCARE ruling, but once in their chart it’s hard to refute.
Seems what usually happens once they stop progressing is that they sequeway from being a “rehab patient” (Medicare & secondary insurance) to a “long term care resident” (Medicare, Medicaid or LTc insurance or private pay). And within their LTC resident plan they will likely get therapy - again will be PT, OT, sometimes ST - but it will not be done as rehabilitation but will be for “maintenance”. And MediCARE will pay for maintenance to some degree maybe twice a week. It usually shows up on the Medicare statements of service as “gait training” for PT time and “use of function” for OT time. Ask the PTs & OTs to explain how it works; they can - if you’re the DPOA and MPOA - show you the history and measurements taken so you can see for yourself what’s what.
Medicare rehab benefit pays like triple what Medicaid will pay per day for room&board. A NH with rehab unit / services will do whatever legitimately to keep a person there under rehab as it flat pays so much more. They are not going to stop rehab just because. If rehab has stopped its because they are not progressing and their chart show this ime.
https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf