Can we convert to Medicare A?

[g8torlpn69]

Ok, we have a resident that was admitted to our facility 5/15/14 on Managed Care. Now her managed care wants to drop her and my facility wants to convert her to Medicare A as her primary payer on 7/1/14. She did have a 3 day hospital stay when she was admitted on 5/15/14 and she continues to receive skilled therapy at a RU level but, my question is that since 7/1/14 is day 48 since her hospital stay does that 30 day rule since being hospitalized come into any play of affecting her ability to be covered under Medicare A? Any advice or information to an explanation to this would be really appreciated. Thanks

[dennisbyron012]

From a SHIP Counselor:

OK, first, the good news is that she never left Medicare Part A. You cannot be on Medicare managed care without first being on Parts A and B.

Second, do you know if it is Medicare Advantage managed care or some special frail-elderly or dual-eligible version of managed care? An important question is why does the managed care plan "want to drop her?" It's all going to depend on what the rules of that managed care plan are but in general it can't just start "dropping people." However, just as with Original Medicare Part A, there is likely a limit on how many days it will pay for full ride and how many it will cover at half, etc.

I would also wonder about the implications of reverting to Original Medicare from the managed care plan in terms of the patient's gap coverage for your facility and other services.

Finally I would not think you could easily restart the clock which is what it sounds like someone wants to do (but again, back to question 2--what is the plan she is on now?)

[Talino]

my question is that since 7/1/14 is day 48 since her hospital stay does that 30 day rule since being hospitalized come into any play of affecting her ability to be covered under Medicare A?

The 30-day rule does not apply. It is simply a continuation of skilled care from the original 3-day hospital stay, but by July 1^st, traditional Med A is now the primary payer. Deduct the total number of benefit days used w/ managed care. Start the PPS schedule until benefits are exhausted or skilled service ends, whichever comes first.