Medicare Guidelines, Services, & FAQs at Rolling Hills
Medicare Information and Guidelines
In order to have a nursing home stay covered by Medicare Part A at Rolling Hills, residents need to meet certain criteria:
- The patient must be enrolled in Medicare Part A at that time of the qualifying hospital stay. You must have a 3 consecutive night inpatient stay to qualify for Medicare A admission. A hospital stay in observation does not qualify per Medicare A requirements.
- Be admitted to Rolling Hills and begin Part A coverage within 30 days of the hospital discharge (the day of discharge is not counted) and be there for the same condition as you were in the hospital for.
- A doctor must certify that you need, and must receive, skilled nursing or skilled rehabilitation services on a daily basis and show daily progress toward set goals.
The decision to admit a patient to the nursing home under the Medicare Benefit is determined by a Registered Nurse and Interdisciplinary Team (IDT) from the facility. The IDT will review your medical record and data from the hospital. Sometimes there is confusion about the need for skilled nursing. This decision can only be made by the admitting nursing home based on the information from the hospital stay and the patient’s condition at the time of admission.
Medicare Frequently Asked Questions
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If a resident qualifies for Nursing Home Medicare Part A, they may receive up to 100 days of coverage per benefit period. He or she will need to have a 3 day (24 hour days) inpatient hospital stay prior to admittance or a 3 day hospitalization within 30 days of admittance to the facility.
Medicare Pays in full for days 1-20.* However, days 21-100 have $185.50 per day co-insurance amount that is the responsibility of the resident. However, this may be covered by private insurance and the insurance company will need to be contacted by your to determine if this will be covered.
*NOTE: This coverage is dependent upon meeting the criteria Medicare has set.
Medicare Covered and Non-Covered Services
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- Semi-private room accommodations, except where private room is medically necessary or semi-private rooms are unavailable.
- Skilled Nursing Care – not private duty nurse.
- Physical Therapy, Speech Therapy, and Occupational Therapy Services furnished by facility or others unless by arrangement. Billing is by the Skilled Nursing Facility.
- Drugs, biologicals, supplies, appliances, and equipment that is used regularly in a Skilled Nursing Facility.
- Other diagnostic or therapy services provided by participating Skilled Nursing Facility
“I enjoy the joy I see in the residents. The activity staff are #1 – it’s a great experience working with you all. Staff are very cooperative and appreciative. Sharing a smile or conversation with a resident is very rewarding.”
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