Eikooc251, I am so sorry to hear of the troubles your mom has had, and all the seemingly endless paperwork, plus the additional burden of possible personal injury claim. I hope you find a competent law office, remember they will usually give a free initial consultation. One hint, keep a running journal of everything you are doing, out of the ordinary, towards your mom's care. When someone calls, reach for your notebook before you pick up phone. Ask them to identify their 1st & last names and spelling and their position & phone number. Write time/date. If any action taken after phone call write that down too. Document what was said in pH cls with a followup email or snail mail letter. Etc etc. Don't rely on your memory. I also will text myself brief notes, which provides a day/time. I make all phone calls from my cell so I can print out a record. The idea is to document your time spent, in ways that cannot be invented--otherwise the other side will try to poke holes in your documentation. With your mom's permission, take photos of her or even a brief video saying hello when you arrive to take care of her. hope this helps.
After 100 days you pay. Not sure how a supplemental would work. You should have been told this going in. After 21 days they don't payfully. Mom owed $152 a day for th rest of her stay.
Is she in rehab at a NH that has a rehab wing, and she went there after a hospitalization? IF that's the case, you need to find out what her status is for "progressing". Speak with the PT, OT or social worker at the facility to see what mom's situation is. IF she has reached a plateau, then there's no more progress so no more Medicare benefit.
She would need to either be rehospitalized for a condition for 3 or more days and then get another rehab order done OR if she is living in the community she could maybe be discharged from rehab back other home but her orthopedic doc or maybe her gerontology doc could do orders for another type of rehab that is a different code for Medicare. My mom - when she was living at her home - had a torn rotor cuff surgery; then went home but onto PT for the maximum rehab under Medicare (she was still living at home); then got re-evlauted by her orthopedic surgeon and referred back to gerontology dept for OT evaluation; she got another maybe 90 days under OT. A lot of the therapy between PT & OT cross over but done by different therapists. It must have different codes in order for all this to work by medicare. A good gerontology group (my mom's was within the gerontology dept of a health science center) know how to dovetail all this so that it can work. Local doc really can't imho. If your mom is in a facility, they may not see the need to go through all this as really it may be that mom can't progress anymore and need to be a full time long term care resident.
You need to find out realistically what her medical ability is.
No there is only 100 days. I used to do hospital claims. You could also look on Medicare website. They are very strict, and getting stricter--no wiggle room. The progress bit is extremely important, they absolutely do not.pay if the pt is no longer making progress.
Thank you both. Mother is in rehab and discharge date is Easter Sunday with no discharge plans made. Today I placed an appeal in her behalf. This facility is now demanding. payment after Sunday. How would I find out about gerontology in NY.?She goes to see her vascular Dr. At Lenox Hill Hospital. Would like info on that .please. I have also called the office of the Ageing. Boy how they treat our seniors is disgraceful! I also will move forward with getting a lawyer for her head being hit while in hoyer lift 3×… and a facility that neglected care. Boy my work is cut out for me!
Malloryg8r. Thank you for your time and your head ups. I continue to also pray. My faith and my mother's faith is strong Karma is real. I have to protect my mother at all times? Are you in NY? I live in NJ and rehab is in NY.
Eikooc251, yes God is real, and I believe there are Angels at work all around us. But we have to do what we can, too. I am not on the East Coast, sorry, but I will continue to remember you in my prayers. I pretty much pray all day long, and at night too (since I hardly sleep thru the nite anymore!).
Mallory - for my moms rotor cuff & PT &OT add on, it was about 10 yrs ago & centered on post surgery codes to get first 100 & then a round 2 on different code. Mom had high option federal BCBS so no cost to her ever. It makes sense that this has been limited now as much is a duplication of services.
Eik - the 100 days is standard Medicare rules. Sometime within the past 100 days there have been care meetings regarding mom where her status was discussed. Your mom has gotten all sorts of info from CMS and probably also her secondary insurance that details benefits over the years. Mom and her POA have the responsibility to know this or ask about benefits. If mom has had her 100, platuead and not progressing, there is no more rehab Medicare benefit paid for the incident. Appeal IMHO is a waste of your energy.
The facility has to do whatever to ensure they will be paid. It's a business and until mom has established qualifying for Medicaid, she is not established to be financially at need.
If you don't do something to work this out, they will likely do one of these: "30 day notice" to mom, you, & either APS or Area on Aging; ask the court to do an emergency ward of the state action; or if mom has psych issues Baker Act her; or you or mom if she is is competent may have to sign off an admissions agreement or contract; or mom applies for Medicaid. Medicaid " pending" admissions usually require the facility reviewing the documents needed so they can determine if they will accept mom as a "pending" resident. Both for my mom & my MIL, the NH (different ones too) reviewed the needed by Medicaid documents first to see if they would accept them as pending. If something seems not ok, they can require an admissions contract be done to have them as pending
Whatever the case, the facility at a minimum will require that mom pay or turn over whatever monthly income she gets - her SS, retirement. Whatever income that issues an annual award letter (SS & most federal, state retirements do these). The awards letters will be needed for the Medicaid application too. If mom has any non exempt assets over 2k, she will have to spend down before Medicaid will approve & pay.
It is going to be easy to be very overwhelmed in all this. Try not to take things personally or be peeved with the facility. The rules are strict and exacting on all this. Good luck.
She would need to either be rehospitalized for a condition for 3 or more days and then get another rehab order done OR if she is living in the community she could maybe be discharged from rehab back other home but her orthopedic doc or maybe her gerontology doc could do orders for another type of rehab that is a different code for Medicare. My mom - when she was living at her home - had a torn rotor cuff surgery; then went home but onto PT for the maximum rehab under Medicare (she was still living at home); then got re-evlauted by her orthopedic surgeon and referred back to gerontology dept for OT evaluation; she got another maybe 90 days under OT. A lot of the therapy between PT & OT cross over but done by different therapists. It must have different codes in order for all this to work by medicare. A good gerontology group (my mom's was within the gerontology dept of a health science center) know how to dovetail all this so that it can work. Local doc really can't imho. If your mom is in a facility, they may not see the need to go through all this as really it may be that mom can't progress anymore and need to be a full time long term care resident.
You need to find out realistically what her medical ability is.
Ageing. Boy how they treat our seniors is disgraceful! I also will move forward with getting a lawyer for her head being hit while in hoyer lift 3×… and a facility that neglected care. Boy my work is cut out for me!
Karma is real. I have to protect my mother at all times? Are you in NY? I live in NJ and rehab is in NY.
Eik - the 100 days is standard Medicare rules. Sometime within the past 100 days there have been care meetings regarding mom where her status was discussed. Your mom has gotten all sorts of info from CMS and probably also her secondary insurance that details benefits over the years. Mom and her POA have the responsibility to know this or ask about benefits. If mom has had her 100, platuead and not progressing, there is no more rehab Medicare benefit paid for the incident. Appeal IMHO is a waste of your energy.
The facility has to do whatever to ensure they will be paid. It's a business and until mom has established qualifying for Medicaid, she is not established to be financially at need.
If you don't do something to work this out, they will likely do one of these:
"30 day notice" to mom, you, & either APS or Area on Aging; ask the court to do an emergency ward of the state action; or if mom has psych issues Baker Act her; or you or mom if she is is competent may have to sign off an admissions agreement or contract; or mom applies for Medicaid. Medicaid " pending" admissions usually require the facility reviewing the documents needed so they can determine if they will accept mom as a "pending" resident. Both for my mom & my MIL, the NH (different ones too) reviewed the needed by Medicaid documents first to see if they would accept them as pending. If something seems not ok, they can require an admissions contract be done to have them as pending
Whatever the case, the facility at a minimum will require that mom pay or turn over whatever monthly income she gets - her SS, retirement. Whatever income that issues an annual award letter (SS & most federal, state retirements do these). The awards letters will be needed for the Medicaid application too. If mom has any non exempt assets over 2k, she will have to spend down before Medicaid will approve & pay.
It is going to be easy to be very overwhelmed in all this. Try not to take things personally or be peeved with the facility. The rules are strict and exacting on all this. Good luck.
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