My Mom stayed at the nursing home with her own pay. She was paying for everything except medications. She paid for oxygen, cpap machine etc. Then on Oct 29 she went into the hospital. Stayed for three days. Returned to the nursing home. I was told that since Medicare had not had a schedule A claim for over 60 days and a three day stay in the hospital that the benefits would have been reset. The nursing home said NO> because she was living at the nursing home and paying out of pocket. Used physical therapy etc. Stayed from 11/1 through 11/24. Mom returned to the hospital on the 24th. The nursing home told me if I didn't pay that she would not be able to return to the nursing home. So (even though I was told by medicare that medicare was responsible) I felt that I had to pay the $8,826.99 bill since they would not agree to let her come back until it was paid. After I paid the bill, they REFUSED to let her return to the facility. I have been through 4 reviews by medicare and they all are saying that the nursing home did not file the claim correctly and I am out of luck. the nursing facility will not even consider they were wrong. SO....since Mom was doing physical therapy, speech therapy etc....would this be considered schedule A. I am at a loss as to where to go next. Please let me know if you have any recommendations
They knew when they were threatening not to let her come back without the money that they weren't accepting her back. Scumbags.
I am so sorry for your loss. May The Lord give you guidance, strength and wisdom to deal with this and may HE give you comfort and peace for your loss.
Is this accurate? Your mom is now deceased?
if so, I think there are 2 different issue’s happening:
- since she is dead, you personally do not have any recourse with NH. NH will take the position that as your mom is no longer a resident & no outstanding bill, that her account is 100% closed. That your ability to do anything on moms behalf via POA does not exist as POA only good while alive, so NH is not answerable to you nor do any review to a settled zero balance bill. A waste of time, energy and emotion imo.
(& if by some miracle they did this, that $8,826.99 will be paid to “Estate Of” so need probate court action & IRS # to deal w/ the $)
If probate opened, you might could file claim against her Estate for $8,826.99 you chose to pay. But if you are executor, that’s going to be way sticky to get done as it could be looked at as “self dealing” unless notarized paperwork that items you paid for on her behalf or property while she was alive can become a debt of her estate. This is something for a probate attorney give guidance on as they know how the judges roll on signing off on these.
- on the rehab / therapist issues, so mom got therapy (PT, speech, maybe OT?); Medicare billed & Medicare paid, that’s what happened, right? If so, MediCARE paid for therapy via the ICD-10 codes for maintenance and not codes for a post hospitalization rehab. Requesting code change once they’ve died and bill settled isn’t going anywhere imo as that NH kinda has no reason to bother.
If she was hospitalized then got discharged under rehab plan, when she went back to the NH, she would be on MediCARE Part A rehab benefit that does a standard 20/21 days at 100% coverage including room & board fees; and then up to 100 days @ 50%, if progressing. But being discharged with rehab orders is NOT a given, as elder may realistically NOT be able to do actions needed for rehab. Elder may not be cognitive enough to go from point A to point B in a measured way so rehab cannot happen as there will be no progress to enter in their chart that is relayed to Medicare.
HOWEVER
elder who is a resident in a NH can have a therapist provided maintenance program that MediCARE will pay for. Like my mom went down to rehab sector 2 X wk to have “gait training” (sitting in hard chair, full stand, walking between parallel bars, pivot turn… rinse & repeat) done to maintain muscle mass and resilience as much as feasible. Maintenance does NOT have the required progress notated in their chart that Medicare rehab requires. Maintenance does not pay for room&board. I bet that it was this type of therapy NH billed & Medicare paid.
Medicare post hospitalization rehab benefit pays NH really well. Like 2-3 times what Medicaid day rate does. Tends to pay more than private pay as rehab can have all sorts of extra charges allowed as post hospitalization care. Because of this, NH billing is going to want to get admission down as a post hospitalization rehab stay. If this NH did not do this, it - imo -probably was they had serious concerns that flat wasn’t feasible for her to do the whatevers needed to show progress sufficiently to be ok for Medicare rehab. & these concerns are also why they would not take her back from the hospital. She posed a level of care needed beyond their ability…. whether accurate or not, it’s a legit move a NH can do to get a resident out of their facility.
Not to sound harsh, but Often we look to find a distraction to keep ourselves busy (& sometimes blame) rather than dealing with elders demise and death. Bereavement is not simple. I think you might be better off using your time & energy to get bereavement counseling. If your mom was on Medicare hospice benefit, that program has resources for counseling. Good luck.
Was your Mom placed in a nursing home permanently? Because if so its her residence and she does pay that bill privately. Medicare does not pay for permanent Nursing home care. Medicaid does if the person has no money.
Medicare A only pays for Rehab that usually follows a hospital stay. It covers 100% for first 20 days and 50% for the next 80 days totaling 100 days. But 100 days is not guaranteed. If the person is not progressing or has reached a plateau Medicare will not pay so the person is discharged from rehab.
IMO, Medicare only owes for Moms hospital stay of 3 days. Mom owes the NH for 11/1 to the 24th and maybe the 3 days in the hospital for holding her bed, to the NH. What I see wrong here is them not allowing her back.
If Mom was in a NH doing Rehab, she should have not paid for her care privately. As I said, Medicare pays for the first 20 days. So from 11/1 to maybe the 20th Mom pays no out of pocket. The 21 st the 24th she pays 50% of the daily fee which does not mount up to over 8k. But if Mom was private pay, that 8k is about right.
I think what is happening here is someone is under the impression that Mom was doing Rehab which A pays for. But the Nursing home has her down as a permanent resident which A does not cover. Her therapy may have been paid by Medicare but not her room and Board.
Really need to know why was Mom in the NH?