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Medicare: Two Tips and Traps

Here is a scenario: Mrs. Green, a widow, is taken by ambulance to the hospital due to a medical emergency. After she has been treated at the hospital, she chooses to move to a rehabilitation facility, or rehab unit of a nursing home. Her family expects her Medicare benefits to pay 100% of her first 20 days in rehab and a portion per day to the 100 days allowable. The family also assumes that Mrs. Green’s Medicare Part A will pay for her hospitalization.

Tip and Trap #1: If Mrs. Green was not an admitted patient at the hospital for at least three midnights in a row Medicare will not pay for her rehab. And, for those days she was not admitted, she will be billed under part B, as an out-patient, which is much more expensive than part A. The medical records must be read to determine the actual time of admission.

Tip and Trap #2: If Mrs. Green avoided the first trap, watch out for the second trap. Medicare rehab treatment and payments must continue up to the maximum of 100 days as long as Mrs. Green’s medical condition is improving, maintained, or even if her deterioration is slowed or prevented as a result of the rehab services.

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