Legal Standard for Obtaining 100 days of Medicare | Medicare Coverage After Hospital Discharge

I have had many clients come to me with a loved one who has a medical event that takes them to the hospital. They are admitted to the hospital for at least 72 hours then are transferred to a skilled nursing facility (SNF) for rehabilitation. The first 20 days are 100% covered by Medicare and then depending on the supplemental insurance, each person is entitled to 100 days of coverage at 60-80%, and maybe 100% depending on the quality/ type of supplemental insurance. THIS IS ONE OF THE IMPORTANT REASONS WE DISLIKE MEDICARE ADVANTAGE PLANS-- THE COVERAGE IS OFTEN TERRIBLE DURING THIS 100 DAYS AFTER HOSPITAL DISCHARGE.
Currently, we are seeing all too often that facilities are trying to discharge our clients around day 27 or day 28 because the patient is "NO LONGER IMPROVING FROM THE THERAPY" and therefore, the facility contends it is time for the patient to leave the Medicare/rehab bed. This is NOT the correct standard. Based on a case from 2013 (JIMMO VS. SEBELLIUS) medicareadvocacy.org/jimmo-v-... the standard for discharge is NOT are they improving, but rather, "IS THE REHABILITATIVE TREATMENT CAUSING THE PATIENT TO DECLINE"....
Between 21 and 100 days, as long at the treatment is not causing decline, the patient qualifies for their full 100 days. Why is the rehabilitative facility trying to discharge the patient? Here's why: the Medicare reimbursements go down the longer the patient stays in the rehab bed. The facility wants the longer staying client out of the rehab bed so they can get a higher reimbursement rate from a patient who has more recently been discharged from the hospital. Know your rights! And Appeal. You do not need an attorney to appeal and the success rate for appeals is, as you can imagine, impressive.
You want your 100 days so you can continue to get stronger; your brain recovers from the anesthesia or trauma you may have suffered; wounds heal with oversight; your day to day responsibilities to feed yourself, your household, and the general stressors of daily life are put on hold while you focus on your recovery and return to daily life. Sometimes it takes 100 days to feel normal again.
We work with the patient's family to appeal these discharges ALL OF THE TIME! And we have hand amazing success. Most importantly, if it is possible for you to get home and not to a facility, using your 100 days is your best chance at success. We all want to be home!
Note: The patient must be compliant with therapy.
Call our office and we can help you. The Medicare consultation fee is $750 to help you submit an appeal that gets approved. We know every part of the process to get it approved.
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Author:
Shannon Miller, Florida Bar Board Certified Elder Law Attorney and founder of The Miller Elder Law Firm, is one of the leading elder law attorneys in Florida with decades of experience advocating for our seniors and adults with disabilities. This level of expertise comes from the thousands of cases she has successfully litigated, her direct advocacy at the state legislature (including drafting legislation) to protect seniors, and collaboration with other stakeholders in improving the lives of seniors and vulnerable adults. She currently serves as Secretary of the Elder Law Section of the Florida Bar.
In addition to the expertise of the firm, what makes The Miller Elder Law Firm special is the way clients are cared for, from the moment they call or visit the office to the conclusion of their case. The mission of every staff member is to help clients through the sometimes complicated process of getting older and suffering the infirmities of aging and death with dignity and independence. The Miller Elder Law Firm team strives to provide every client with a bright retirement and end of life that is as full as possible. Everyone deserves to be heard, protected and confident in their end of life plan.

[@rooseveltsmith540]

We appealed she got denied

[@tom_olofsson]

Very good explanation. I am seeing this more often lately.

[@suzayn]

Hello! My mother is in skilled nursing right now. We just got her discharge notice she is supposed to be discharged Saturday August 18, 2023. The 20th day was yesterday. I called the number on the discharge notice and started the first appeal just now.
I tried calling your office to see if you could help us, but they said you don’t handle these. we are in California is it necessary to have a California bar attorney or is it possible that you or someone else can help us with this in any state?

[@themillerelderlawfirm1508]

We do not practice in California, but you could contact the Life Care Planning Law Firms Association and look at their attorney directory. www.lcplfa.org/ Thank you for reaching out.

[@sandrabrown2757]

What about Advanatge plans. Is it the same rules?😊

[@themillerelderlawfirm1508]

Here's some info about Medicare Advantage plans: th-cam.com/video/Q7XWV2dx-Zo/w-d-xo.htmlsi=pCykWzEE3Hfi3i0a