Medicare & subacute healthcare

Medicare coverage criteria: 1) patient must have a 3 day hospital stay within the past 30 days for a related diagnosis 2) specific Medicare covered services 3) patient must have clear potential for improvement 4) patient requires skilled nursing or skilled rehabilitation services on a daily basis 5) daily services as a practical manner can be provided only on an inpatient basis 6) if there is an alternative available, it must be more economical & feasible for the patient to be treated as an inpatient 7) daily skilled services must be medically appropriate Examples of Medicare covered services (Eligibility criteria): 1) parenteral therapy 2) physical therapy 3) occupational therapy (to support independent level of function) 4) weaning oxygen with arterial blood gases (ABG) 3 times/week 5) tracheal suctioning at least twice a shift 6) daily sterile wound care 7) intensive medical monitoring/skilled nursing observation for unstable medical conditions 8) adjustment of pain management Medicare discharge criteria: 1) goals have been achieved 2) daily skilled nursing or skilled rehabilitation is no longer required 3) patient is unable to participate in the treatment program due to medical, psychological or social complications 4) goals are no longer realistic & no new goals are established

Related

Medicare Medicare reimbursed services at skilled nursing facility (SNF) level

References

Smith, R. Jewish Home for the Aging, Reseda CA, 2001, unpublished