Your Medical Condition Does Not Always Have to Improve to Qualify for Medicare Coverage

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County Elder Care and Medicare Attorney

Medicare Beneficiaries who are discharged from a hospital can qualify for Medicare Coverage of Skilled Nursing Care under specific circumstances.  I’ve listed these circumstances for you below:

  • The skilled nursing facility care was ordered by a physician;
  • The individual had a prior three-day inpatient hospital stay (not counting the day of discharge), before the nursing home admission. (Medicare Advantage plans may not include this requirement.) Generally, this means the individual must have been formally admitted to the hospital as an inpatient, not as what’s known as an “outpatient” on Observation Status, must be an inpatient for a period that spans at least three midnights. Usually, the nursing home admission must be within thirty days of leaving the hospital;
  • The individual must need and receive daily skilled nursing and/or therapy which must be provided by, or under the supervision of, qualified personnel in order to be safe and effective. To meet the daily requirement, the individual must receive skilled nursing care seven days a week, skilled therapy services five days a week, or a combination of both skilled nursing and skilled therapy seven days a week;
  • The skilled nursing and skilled therapy must be necessary to improve, maintain, prevent, or slow the decline of the individual’s condition;
  • The skilled nursing facility care must be for a condition for which the individual was hospitalized or that arose at the skilled nursing facility while being treated for a condition for which he/she was hospitalized.
  • As a practical matter, the skilled services must be required to be provided on an inpatient basis

Patients who meet these Medicare criteria can qualify for Medicare coverage.

To discuss your NJ Medicare matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com. Please ask us about our video conferencing consultations if you are unable to come to our office.

 

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