Reestablishing Skilled Days Once Discharged From Therapy

Question

Answer

The only way now that you get your days back is when you have what is called a 60-day spell of wellness.  It is 60 consecutive calendar days and it must be a break of an inpatient hospital stay.  It could even be one night and that resets the clock back to the 60-day counting again, or skilled nursing services.  You do not have to use all 100 days to qualify for starting your 60-day break.  Your 60-day break automatically starts the day after you have discharged the patient completely from their Medicare benefit.  For example, it is July and the patient is ready to be discharged, but they have only used 45 days of their part A benefit.  We discharge them in July.  The patient is a long-term resident and they remain at the facility.  They do really well in August and September, but in October, they have a set back and are back in the hospital.  They have the three-night admission stay.  They get readmitted back to our facility and need therapy again.  We will restart that patient at 100 full days of Medicare benefit, because they had their 60-day spell of wellness during the month of August and September.  It would start the day after they were discharged in July.  If that patient ends up being readmitted for the three-day qualifying hospital stay on day 59 or sooner and it is before the 60 days took place, they simply pick back up on the remaining days in their bank, which in this case would be 55 days.  They would just continue being skilled for either 55 more days or until they are ready to be discharged sooner than the 55 days.  If they need skilled care beyond 55 days, then from the therapy point of view, we transfer them to the part B Medicare status and continue billing under part B.  However Medicare part A has ended and the patient will be responsible for the room and board, which is usually picked up through Medicaid or the private pay situations.