Does this qualify for Medicare?

[Gaby63]

A recent admission Medicare became effective 4/1. Qualifying hospital stay 3/5 till 3/11. Please help clarify which is correct.

1) no, because hospital stay must be AFTER Medicare becomes effective.

2) yes, because it is within a 30 day window of hospital stay.

thank you, and it would help also if anyone could point out this is covered.

G

[Talino]

No, if 4/1 is day 1 of Medicare entitlement.

Medicare Benefit Policy Manual Chapter 8 - Coverage of Extended Care (SNF) Services Under Hospital Insurance

Yes, if resident was formerly on managed care Medicare, disenrolled, and now switched to traditional Medicare effective 4/1.

Medicare Claims Processing Manual Chapter 6 - SNF Inpatient Part A Billing and SNF Consolidated Billing

[Gaby63]

No, if 4/1 is day 1 of Medicare entitlement.

Medicare Benefit Policy Manual Chapter 8 - Coverage of Extended Care (SNF) Services Under Hospital Insurance

Yes, if resident was formerly on managed care Medicare, disenrolled, and now switched to traditional Medicare effective 4/1.

Medicare Claims Processing Manual Chapter 6 - SNF Inpatient Part A Billing and SNF Consolidated Billing

Thank you, Talino....I'm grasping here at the word "entitlement".... This resident became eligible for Medicare in 2000, wasn't aware of it till recently, after being cut by an HMO in another facility after only about 19 days, then came to our facility.....so MC effective 4/1/14 is the date we have to go by, not the year 2000 eligibility, correct? I'm just trying to help out a family whose finances are worn thin .....

[Talino]

Assuming resident is receiving skilled service at your facility -

Is resident still enrolled w/ HMO (managed care Medicare)? If Yes, HMO need to authorize skilled care at your facility and you cannot use traditional Medicare.

If disenrolled and has switched to traditional Medicare as of 4/1, then you will deduct 19 days (used while w/ HMO). Resident will now have 81 benefit days available through Medicare part A.