Reply to Please help! Medicare Part A SNF facility coverage after hosp for long term care patient

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[quote=Anonymous][quote=Anonymous]I wonder if the COVID SNF stay/payments were under the waiver but then maybe additional paperwork wasn't done to continue the new benefit period: https://www.ahcancal.org/Survey-Regulatory-Legal/Emergency-Preparedness/Documents/COVID19/3-Day%20Waiver%20FAQ.pdf

Speculation and I didn't fully read to know how it all works, but perhaps looking into because I don't think the original benefit period ends based on 60 days without Medicare payment. It ends based on level of care, and if he's been private paying for skilled nursing then he still was at SNF level of care (if I'm following the timeline correctly in that he never left that level of care).

[/quote]

Also the PHE was renewed (to address the part about at least through April 21 on my first link): https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-15April2021.aspx

I think your best bet would be get documentation of why he needed the SNF new benefit period for COVID and why he needed that to continue for 100 days and ignore that subsequent hospitalization because he appears to have started a new benefit period when they started billing for the COVID.

I know you said ignore Tricare, but I thought Tricare was supposed to pay as long as medically necessary. So for me that angle would be that if Tricare wasn't paying, it wasn't medically necessary for him to be at SNF level of care past September, which would then mean there really was a &gt;60 day break by February, allowing a new benefit period to start for the COVID regardless of the waiver I mentioned above.

Or else I would think Tricare should have still been paying....[/quote]

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