I tell you – I learn something every day on this job. Today’s lesson is about Medicare’s 30-day rule. I tell you this so you don’t have to endure the additional stress I did when my father was rushed to the hospital from his skilled nursing facility when he started to bleed internally. I was not only worried about my father but also whether he had just screwed up the 100 days of skilled nursing eligibility with Medicare he had qualified for with this recent hip surgery.
The typical eligibility rules state that you must be “out of the system” (meaning healthy) for 60 consecutive days in order for an incident to re-set the clock making a patient eligible for another 100 days of skilled nursing care. My father had been healthy for 61 days.
He was getting skilled care when he started bleeding internally and was rushed back to the hospital after only 10 days of skilled care. Normally, in order to be Medicare eligible for skilled services, a patient has to be in the hospital for 3 days (admitted, not just under observation) before you are eligible for Medicare. I was stressed because I didn’t know whether he would be there for 3 days and if he wasn’t, I was worried that he wouldn’t be eligible for skilled services after he was released because he went back into the hospital. And he certainly wasn’t walking yet.
HERE’S HOW IT WORKS
If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay. BUT….if you go back into the hospital within that 30 days period, the skilled care just continues on from where you left off – no need for a new hospital stay. Knowing that would have relieved that element of stress I was experiencing.
As it turned out, my dad was in the hospital for 3 nights, 2 of which were in the ICU. He had lost 25% of his blood in one day from an ulcer in his small intestine that had been aggravated by the blood thinners which are routinely given after hip surgery (to prevent blood clots from forming).
Happy to say, he is out of the hospital and back into rehab. My only disappointment was that I was not able to send him back to the same skilled nursing facility he had been at, which, in my opinion, was top notch. In my next blog post, I will talk about what I wish I had done and could have done to avoid having to move him to yet another new environment….if I only had a crystal ball.
Please share this important information with your friends and family. You never know when you will need it. It is good info to file away in the back of your mind. Because someday, we will all have the privilege of growing old.