Assuring Medicare Coverage for Rehab Days

Medicare provides some coverage for residents receiving rehabilitation or physical therapy in a facility such as a nursing home. I order to qualify for this coverage, Medicare requires a 3 day hospital stay and a skilled care need. To meet the 3 day requirement, hospital days are counted only if you are actually admitted to the hospital as an inpatient. If you are in the hospital for observation or as an outpatient, the days do not count.

In addition to the 3 day hospital stay, Medicare requires that the rehabilitation begin within a short time, generally 30 days, of leaving the hospital. Medicare will cover a stay for rehabilitation for up to 20 days in full and all but $148 co-pay (2013 figure) for the next 80 days for a maximum of 100 days of coverage. The co-pay is covered by some Medicare Supplement plans. You will be billed the co-pay if you are not covered by a plan. The coverage is terminated prior to the 100 days if it is determined that the rehabilitation efforts are not providing any benefit. Please note that Medicare plans other than direct Medicare coverage, such as HMO’s, may have different requirements.

There are currently legislative efforts to change the 3 day hospital stay to include outpatient and observation days.

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