McareA, McareB, Skilled Mcaid, 60 day break

[fulzgold]

Can someone explain Mcare A, Mcare B, Skilled and 60 day break? Do you do OBRA for privateINS, or follow PPS? Thanks

[CapeCodMermaid, RN]

To explain all those items, it would take hours. Do you have more specific questions?

[fulzgold]

OK. I guess I don't know how to ask. Where can I find information on these payor sources, re: what they cover and when. Thanks

[CapeCodMermaid, RN]

Do you have computer skills? Have you heard of google? Go to Medicare.gov

[susanthomas1954]

Medicare A is inpatient, Medicare B is outpatient, including skilled PT/OT when a patient in a SNF is not under a skilled stay (Medicare A, and HMO,or private insurance paying a per-diem rate) A 60 day break is when Medicare A skilled services end, and the patient receives no "skilled services" for at least 60 days. Then they start over with a new 100 day certified SNF stay if they have a 3 day hospital stay and have a skilled need. A patient who is taken off skilled services has a "30 day window," in which to be picked up again under Med A. If it is between 30 and 60 days, the patient does not usually qualify for a new stay.

Our corporation requires us to PPS all private insurance and HMO recipients, even when the coverage does not meet PPS guidelines

[fulzgold]

Thank you, that clears up alot.

[amylpn24]

Treat every payor source as if it were medicare or medicaid. This will save you a lot of pain in the long run when you find out that the resident was actually medicare and NOT private insurance.

[amglpn]

This is what we do too. But if they are ins/MC and under 65 we will treat them like ins and just do admission assessment