Medicareless Rehab Billing Practices

By Larry Teren

Okay, you want to know why Medicare is going bankrupt? Because of policy-making decisions such as the following that recently happened to Ma.

Ma had to spend a couple of weeks in a rehab facility getting physical therapy to get her back on her feet after a mysterious virus and reaction as well to an antibiotic knocked her out of commission. She spent a few days in one hospital while they tried to figure out what was actually wrong. When the doctors threw in the towel, I took Ma to a second, more capably staffed hospital and they quickly resolved her disorder and gave her appropriate medicine that started her back on the road to being herself.

However, she still could not stand without help. This is what happens when you are older and off of your feet for several days. It also didn’t help that close to a year earlier she had broken her second hip and was anyways used to walking with a cane outdoors.

As she had spent at least three days in the first hospital with an ‘inpatient’ status and not just for observation, Medicare was obliged to cover her at a rehabilitation facility as long as she was showing an effort to get better. In other words, if she couldn’t do the physical therapy- if she was never going to walk again, all bets were off and she would have to spend an eternity at an nursing home care facility as a private pay customer.

Decisions would be made on a daily basis by the certified staff physical therapists if she was showing improvement or was wasting their time. Because she was not a candidate for dementia or Alzheimer, it was just a matter of getting back on her feet with the appropriate confidence. She went through two-a-day sessions- one of physical therapy and the other of occupational therapy. Before seven days were up, she was walking almost to the same level as she was before the illness. It was now just a matter of the infection clearing up and returning to full strength.

Medicare, however, only covers 100% up to 20 days. After that, it is a matter of the part B insurance company kicking in a portion and the patient the rest. A rehab facility can be an expensive experience considering that not only does the person get a room for the night as well as the physical therapy, but also gets three meals a day and some entertainment.

After two weeks, Ma was ready to go home and planned on doing so on a Sunday. However, the nursing home / rehab facility in question did not schedule physical therapy sessions on Saturday but on Sunday instead . When Ma decided she wanted to go home on Sunday, they told her that if she did, she would be obligated to pay for the last day she stayed overnight which was Saturday. This was because they had no way to certify that she had fulfilled her physical therapy obligation properly for that day as there was no therapist in the building. However, if she waited until Monday, it would be no problem to get a therapist to certify her completion of therapy on Sunday and Medicare would then be obligated to cover her through that day as she left on Monday morning.

To recap, Medicare was willing to pay for two extra days of her rehab stay at the nursing home because of a lack of proper certification while she was willing to say,”forget it- let me go home a day early and save yourself some money.” And now you know another reason why Medicare is becoming non-sustainable.

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