Medicare and secondary insurance reimbursement. Any thoughts?

I am with Worried about if there was an overpayment, the NH needs to pay it back. Or insurance will find their error and take it back. Have you received an actual statement showing there is a credit on Moms account from the NH? Do you have Statements from Medicare and your supplimental showing a overpayment?

To answer ur question to me. The 100 days that Medicare allows is not a given. Medicare monitors the care of the patient in rehab. There is criteria that has to be met for Medicare to continue to pay. If the person meets a plateau and no further therapy will help, then Medicare says they need to be discharged and won't pay for any continued care. So if 24/7 care is suggested, its either transition the patient to LTC private paying or Medicaid, taking home to care for them or hire caregivers.

I haven't seen a rehab bill in years but because of how billing is done between Medicare and supplimentals I just can't see them overpaying. Lets say:

$300 is the daily rate
150 50% Medicare pays, that leaves 150 left over that the
supplimental may pay. And since the supplimental doesn't
pay until they see what Medicare pays, I don't see where
they would pay more.

I handled my Moms Medicare and supplimental for years and mine too. I have never seen an overpayment. Like Worried said, if a facility or Dr gets overpaid its their obligation to pay it back. I would be surprised that the next payment to the home in your Moms name doesn't have that overage amount deducted.

The insurance overpaying doesn’t entitle your MIL to a credit. If anything it entitles the insurance to a refund I would think (if they were overcharged)

Part of the problem is NH is declaring the care my mother is receiving is strictly custodial so that seems to throw out any chance of further reimbursement. She was on oxygen for a good portion but it was already explained to me that was not in the skilled nursing category because she could have oxygen administered at home. She is completely immobile in all areas but short of being catheterized her care is not in the skilled category. We expect to be paying. We just felt they were overpaid for a certain time. Their explanations make our heads spin. At this facility they have a benevolence plan. I will hope my mother will qualify once her money is gone as she spent 4 years in the AL facility before becoming very ill and we are well out of the 5 year look back. It is doubtful she will ever walk but she is ambulating with her wheelchair which is a big improvement.

Sorry, but this is confusing. Medicare only pays for rehab. 20days 100%, 80 days 50%.. after 20days the supplimental may pay the balance but in my instance my Mom paid $150 a day and that was a few years back.

I have never heard that Medicare and a suppliment pay more than billed. But then, I maybe wrong.