Medicare Rehabilitation Standard Finally Revised
The long awaited update for Medicare rehabilitative
services coverage is finally here. The Center for Medicare & Medicaid
Services (CMS) has finally updated its Medicare manual regarding coverage for
patients receiving rehabilitative services. This necessary change will
help patients and their families advocate for additional Medicare covered services.
Under traditional Medicare, the first twenty (20)
days in rehab are covered one hundred percent; days twenty-one (21) through day
one hundred are paid at eighty percent (80%) by Medicare and the patient is
responsible for the remaining twenty percent. Usually around day 20 the
rehab facility would re-assess a patient and in many situations
stop providing rehab services on the basis that "the patient is
not likely to improve" or "has plateaued."
Now, there is no longer an 'improvement standard' to determine
whether Medicare will provide coverage for a patient needing skilled
nursing care. Medicare now recognizes that skilled care or rehab services
may be necessary to maintain the level reached by the patient (and prevent further decline).
The new standard applies to skilled nursing services, home health services and
out-patient therapy. Click
here to read the transmittal on the CMS website.
Here is a helpful tip: if a rehabilitative
facility tells a patient they are terminating rehabilitative services, the patient can request that services
continue and that the facility bill Medicare. If Medicare agrees with the
patient it will pay the facility; if Medicare disagrees with the patient and
denies the claim then the patient is responsible for payment. This is referred
to as 'demand billing.'
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