Sometimes after a hospitalization or surgery, individuals require additional assistance or rehabilitative services prior to their return home. This care is often provided at a skilled nursing facility in the community.
For those who have Medicare as their primary insurance, guidelines dictate that in order to go into a skilled nursing facility for rehabilitative services or skilled care, you must have had a consecutive three-night inpatient stay in the hospital within the past 30 days.
In the past when you became a hospital patient, you were automatically considered “inpatient,” but that is not the case anymore. There are other levels of care within the hospital, depending on what work up and treatment you are receiving and the severity of your illness. Other levels of care include “observation,” “outpatient in a bed,” or “Emergency Department visit only”—these are not considered inpatient care, even though you are being treated in the hospital. They are billed differently and determine access to different resources when you are ready for discharge.
It is also important to note that there are many surgeries that once guaranteed an inpatient hospital stay that are now being done on a same-day surgery, outpatient basis. If you have been in the hospital under any of these levels of care, you will not likely have access to that skilled nursing facility benefit under Medicare.
If you are in the hospital or planning to come to the hospital for surgery, it is important to understand what your status will be, as that can directly impact what resources are available to you when you are ready to leave the hospital. For patients who are currently in the hospital, the Care Management department can help answer questions about care; if you’re getting ready to enter the hospital for surgery, call Care Connect at 410-871-7000 for assistance.
Kathleen Zilonis is a psychosocial health navigator at Carroll Hospital.
