Posted by Martha on 3/2/2008, 10:39 pm, in reply to "Audits regarding Medicare hospital care"
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I'm quite familiar with the rehab program since my mother was in the hospital and out to a skilled nursing facility twice before her final hospitalization and subsequent death last week. When a person has been seriously ill and requires continued treatment, i.e. intravenous antibiotics, breathing treatments, physical and occupational therapy, etc. they can be transferred from a hospital to a skilled nursing facility. Skilled nursing facilities in most cases are a part of a nursing home. In order to be reimbursed by Medicare for skilled nursing, rehab, etc., the facility must be a Medicare certified skilled nursing facility. Not all nursing homes have that certification. I ran across one facility that was interesting in that it had dual certification for both its skilled nursing hall and its long-term care hall. That enabled them to have skilled nursing patients housed in the long-term care rooms when necessary. Possibly the person you referenced was released to a nursing facility that did not have the Medicare skilled nursing facility certification. It is really important to have a knowledgeable case manager at your hospital who understands all of these requirements. It was quite an interesting journey I've been on and I've learned a lot. I'm pleased that Medicare is becoming more proactive and trying to bring some integrity into the programs. It's long overdue.

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