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Medicare Cost
LOS ANGELES (AP) - A man who allegedly recruited and paid homeless people to receive unneeded medical care in a scheme to charge the government millions of dollars reached a plea deal in U.S. District Court. Estill Mitts faces 25 years in prison and ...
Publ.Date : Fri, 29 Aug 2008 15:22:00 GMT
WASHINGTON, Aug. 29 /PRNewswire-USNewswire/ -- Miami resident Juan Carlos Castaneda, 47, pleaded guilty today to participating in a conspiracy to launder approximately $3.8 million in proceeds from several Medicare fraud schemes, Acting Assistant ...
Publ.Date : Fri, 29 Aug 2008 18:56:00 GMT
Last year, a UConn Law School student gathered donations to send pizzas to homeless shelters in the state. It was a statement against the death penalty, after Tennessee officials denied a death row inmate's request to replace his last meal with a ...
Publ.Date : Fri, 29 Aug 2008 21:05:00 GMT
Like a rusty wheel, the John McCain camp keeps saying a President Obama would raise taxes, and I know a lot of trusting Nevadans believe that is true. Now, Sen. McCain isn’t lying to you, he’s just being misleading. You see, a President Obama ...
Publ.Date : Fri, 29 Aug 2008 21:05:00 GMT
When a drug goes generic, the price plunges. But the formula Medicare uses to pay for certain drugs is slow to reflect that price drop, which means the program winds up overpaying for months. Read all about it in this report out today from Health and ...
Publ.Date : Wed, 27 Aug 2008 20:46:00 GMT
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How Will You Pay For Skilled
Rehabilitation In The Nursing Home
by Tammy Gonzales
One of the most frustrating events for individuals facing rehabilitation is
thinking that their insurance is going to pay for everything and finding out
that their insurance will not pay for the complete services required for a
successful rehabilitation.
Nursing home skilled units want to be assured that the necessary steps will be
taken to assure that they will be paid. Nursing homes are most familiar with
Original Medicare, Medicare Advantage Plans, Medicare Managed Care Plans,
Medicare Preferred Provider Organization Plans, Medicare Private Fee-for-Service
Plans, Medicare Specialty Plans, federal employee health program, military
health program and railroad retirement programs. If your patient has one of
these, they will be highly considered once that payer source is verified.
Medicare Part A is the primary source of insurance that will pay for a skilled
nursing home stay. Medicare pays 100% of day 1 through day 20 and from day 21 up
to day 100 Medicare will pay everything less $114.00 per day co-pay as long as
the resident is making progress towards their rehabilitation goals.
If, Medicare is managed through a HMO (Health Management Organization) it
usually pays 100% of the rehabilitation stay. The HMO determines the length of
stay by the assessments provided to them by the nursing home rehabilitation
staff and the level of independence required where the resident will reside
after their rehabilitation stay. The HMO utilizes a Nurse Case Manager and a
Medical Director who is a physician to make this determination.
Secondary insurances with Medicare Supplemental Coverage will usually pay the
$114.00 per day co-pay from day 21 through day 30 up to day 100 depending upon
the tier level of the insurance plan and some tiers will some times pay up to
120 days. It is important for you to know what your insurance will cover.
If you have the resources you can of course pay the Medicare $114.00 per day
co-pay privately.
Most states offer a Medicaid Program for individuals who meet the financial
eligibility and medical need criteria. Please contact your States Department of
Human Services Income Support Division (local Medicaid office) to see if you or
your loved one meets the criteria for assistance. Most individuals fear that
they may loose their home or all of their income and assets if they apply for
assistance. There are laws and regulations in each state that provides Medicaid
to protect the home or homestead and to protect the spouse from poverty. There
are also attorneys that specialize in Elder Law that can help you protect your
income and assets and plan for the transition to State Medicaid Assistance when
you or your loved ones resources become exhausted.
Nursing homes generate income from providing rehabilitation services to keep
financially afloat. They check to see that they will make a profit from
providing the patient the services they need. That means that everything the
patient needs in the way of treatments, therapy and medications must be covered
by your insurance before they agree to accept a patient from a hospital.
The nursing home will also want to get an understanding of the patients
cognitive status and psycho/social-well-being to see that they are appropriate
for their facility unless they have a contract with the discharging hospital.
Keep in mind that not all nursing homes are adapted to serve all types of
patients. If you or loved one has some behavioral issues, related to dementia,
Alzheimers disease or psychiatric problems they may not be accepted for
admission. You may need to find a nursing home that specializes for those types
of paient needs.
Understanding your insurance benefits and your needs will get you the services
you require for a successful rehabilitation stay.
Tammy Gonzales, Life Coach and Advocate to Caregivers, of Revitalife Coaching
& Consulting, LLC guides Baby-Boomers and the Sandwich Generation on how to take
initiative to manage aging and caregiving before it becomes a crisis. Visit
www.caregiverinfonline.com for more information.
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