Discusses common therapy terms and guidelines. Attempts to simplify therapy  to all consumers. Understanding therapy - one blog at a time!

TOPIC: a “qualifying hospital stay"

To understand therapy is to also understand how skilled therapy services are being covered.  We are posting a portion of what the Medicare's booklet says regarding a qualifying hospital stay.

"REMEMBER: Even if you stay overnight in a regular hospital bed, you might be an outpatient. Ask the doctor or hospital.

How would my hospital status affect the way Medicare covers my care in a skilled nursing facility (SNF)?  Medicare will only cover care you get in a SNF if you first have a “qualifying hospital stay.”

• A qualifying hospital stay means you’ve been a hospital inpatient for at least 3 days in a row (counting the day you were admitted as an inpatient, but not counting the day of your discharge).

• If you don’t have a 3-day inpatient hospital stay and you need care after your
discharge from the hospital, ask if you can get care in other settings (like home
health care) or if any other programs (like Medicaid or Veterans’ benefits) can cover
your SNF care. Always ask your doctor or hospital staff if Medicare will cover
your SNF stay.

How would hospital observation services affect my SNF coverage? Your doctor may order “observation services” to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you’re getting observation services in the hospital, you’re considered an outpatient. This means you can’t count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay. "

The US health care system is changing and you should ask your doctor or hospital staff about insurance coverage with your therapy and other related services.

To learn more you should visit Medicare's website regarding this very important topic.

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• Starfish Therapies- Pediatric blog. Author- Stacy, Starfish Therapies’ founder, is a pediatric physical therapist with both a Masters and a Doctorate in Physical Therapy from Boston University and is a board certified pediatric clinical specialist.

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