Medicare rules about rehab coverage can be tricky. Pay attention to the following myths:
1. After a hospitalization, rehab coverage under Medicare A is pretty much guaranteed.
Not always. Rehab in a skilled nursing facility requires three overnights in the hospital. In addition, the person must need skilled services, such as Physical Therapy, Occuptional Therapy or extensive nursing care. An attending physician must write orders for these services and must justify them according to the rules of Medicare.
2. People can stay 100 days in a rehab center under Medicare A.
It's rare for someone to actually qualify to stay the full 100 days. The length of stay is determined by the person's diagnosis and his or her progress. Rehab staff chart the progress and report weekly. When a person "plateaus,' or stops improving, the rehab staff gives written notice, informing the person of the last covered day under Medicare A.
3. Medicare A services in a rehab center are covered in full by the Medicare program.
Medicare A covers the first 20 days: room and board, therapies and most supplies. At Day 21, there is a copay of $134 or higher, depending on a person's income. Copays are often paid by a person's health insurance.
4. After a person leaves a rehab center, he or she can no longer receive therapies.
Therapies can continue, providing the physician writes the orders that these will benefit the patient and comply with Medicare guidelines. These therapies are performed less often, and can be done in an out-patient center or in a person's home. They're covered under Medicare B. There is a copay.
5. Medicare gives you a lot of choices for rehab centers after hospitalization.
If you or a loved one have traditional Medicare coverage, you can choose virtually any nursing home in your area for rehab. If you have a managed care insurance, such as a Medicare Complete Plan or Tricare for military families, you may be restricted in your choices of rehab centers.
Tuesday, January 31, 2017
Monday, January 9, 2017
Saturday mornings, I listen to two radio programs about senior care: Leading Edge Medicine, hosted by Jerry Mixon, MD, and AgingOptions, hosted by Rajiv Nagaich. Each has its own distinctives. Mixon's show emphasizes keeping healthy no matter one's age. Nagaich's program focuses on the legal, financial and medical aspects of aging.
Last Saturday Aging Options featured Chad Boldt, MD, a renowned geriatrician. Geriatricians specialize in treating older people, especially those with multiple chronic diseases.
Could your parent or loved one benefit from a geriatrician? Ask yourself these questions, which may lead you to opting for a geriatrician.
1. Does your loved one suffer from four or more chronic diseases? An example would be someone who has diabetes, congestive heart failure, depression and chronic pain. In 2010 37% of people on Medicare fit that description. Often these patients are 85 or older and have dementia.
2. Does your loved one take lots of medications? "Nobody should take 20 or more medications," says Dr. Boldt. More certainly doesn't mean better, since medications can interact negatively with each other.
3. Does your loved one get confused when multiple specialists give instructions? As people become more frail, they may not be able to understand and comply with instructions by several physicians.
A geriatrician specializes in the elderly, especially who are medically complex. This specialty requires extra training beyond that of a medical doctor. And unfortunately, says Dr. Boldt, fewer doctors are entering this field than in the past.
So what questions do you ask a prospective geriatrician? Nagaich suggest these:
1. Are you a Certified Board Physician in Geriatrics? There may not be a geriatrician in your area, however. Many primary care physicians have experience in geriatrics.
2. Are you accepting new patients?
3. Will you take my insurance?
Nagaich also suggests that if possible, people look for doctor who has good experience but who is in his or her 50s.
Another way to provide specialized care to older, frail adults is through a team approach. A physician with expertise in geriatrics oversees the care of patients who receive direct care from a specially trained Registered Nurse, plus other staff. Dr. Boldt participates in a program called Guided Care, in which one doctor and one specially trained nurse work together to manage medications and give directions to patients and families.
Is your loved one a candidate for a geriatrician?