Medicare

Medicare may cover skilled care in a skilled nursing facility (SNF) for up to 100 days. To qualify for skilled care reimbursement, the patient must require skilled nursing or rehabilitation staff for medical management, observation, and evaluation on a daily basis. Examples of skilled care include changing sterile dressings, feeding tube care, IV fluids and care and physical therapy for rehabilitation. Services that can be provided by non-professional staff do not qualify as skilled care.

Medicare will cover skilled care only if all of the following conditions are met:

1. You have Medicare Part A (Hospital Insurance) with days remaining in your benefit period.

2. You have a qualifying inpatient hospital stay of three consecutive days or more, not including the day you leave the hospital. You must enter the SNF within a short time (generally 30 days) of leaving the hospital and require skilled services related to your hospital stay. If you reenter the same or another SNF within 30 days of discharge from a SNF facility, you don’t need another qualifying hospital stay to get additional SNF benefits. This is also true if you stop receiving skilled care while in the SNF and then start receiving skilled care again within 30 days of the stopping of that skilled care.

3. Your doctor has decided that you need daily skilled care. Skilled care must be given by, or under the direct supervision of, skilled nursing or rehabilitation staff. If you are in an SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just five or six days a week.

4. You receive the skilled services in a Medicare-certified nursing facility.

5. You need these skilled services for a medical condition that either:

a. Was treated during a qualifying three-day hospital stay
b. Started while you were getting Medicare-covered SNF care

For more information, contact us.