Medicare & subacute healthcare

Introduction

Medicare coverage criteria:

• patient must have a 3 day hospital stay within the past 30 days for a related diagnosis
• specific Medicare covered services
• patient must have clear potential for improvement
• patient requires skilled nursing or skilled rehabilitation services on a daily basis
• daily services as a practical manner can be provided only on an inpatient basis
• if there is an alternative available, it must be more economical & feasible for the patient to be treated as an inpatient
• daily skilled services must be medically appropriate

Examples of Medicare covered services (Eligibility criteria):

• parenteral therapy
• physical therapy
• occupational therapy (to support independent level of function)
• weaning oxygen with arterial blood gases (ABG) 3 times/week
• tracheal suctioning at least twice a shift
• daily sterile wound care
• intensive medical monitoring/skilled nursing observation for unstable medical conditions
• adjustment of pain management

Medicare discharge criteria:

• goals have been achieved
• daily skilled nursing or skilled rehabilitation is no longer required
• patient is unable to participate in the treatment program due to medical, psychological or social complications
• goals are no longer realistic & no new goals are established

Additional terms

• Medicare
• Medicare reimbursed services at skilled nursing facility (SNF) level