My mother who was a resident in assisted living was admitted to the hospital on November 10th. She was released to compassionate/palliative care at the nursing home connected to the assisted living facility on November 19th. As of December 26th, she was no longer under the Medicare payment plan. The nursing home feels she had improved, although she was still on oxygen at the time. Her care is now considered custodial, so it is full self pay. Our thoughts were that we might be entitled to a credit towards her future bill of what the secondary paid as the Medicare and secondary amounts exceeded the daily rate I was given once she was on self pay. I appreciate any thoughts on this as I know some of you are very knowledgeable in this area.
I have never heard that Medicare and a suppliment pay more than billed. But then, I maybe wrong.
I realize this is a special situation. I am just trying to understand if this is ethical or customary.
To answer ur question to me. The 100 days that Medicare allows is not a given. Medicare monitors the care of the patient in rehab. There is criteria that has to be met for Medicare to continue to pay. If the person meets a plateau and no further therapy will help, then Medicare says they need to be discharged and won't pay for any continued care. So if 24/7 care is suggested, its either transition the patient to LTC private paying or Medicaid, taking home to care for them or hire caregivers.
I haven't seen a rehab bill in years but because of how billing is done between Medicare and supplimentals I just can't see them overpaying. Lets say:
$300 is the daily rate
150 50% Medicare pays, that leaves 150 left over that the
supplimental may pay. And since the supplimental doesn't
pay until they see what Medicare pays, I don't see where
they would pay more.
I handled my Moms Medicare and supplimental for years and mine too. I have never seen an overpayment. Like Worried said, if a facility or Dr gets overpaid its their obligation to pay it back. I would be surprised that the next payment to the home in your Moms name doesn't have that overage amount deducted.