Consider this. You have Medicare coverage. You’ve been in the hospital for three or four days and your doctor determines that you need to go to a rehabilitation facility (also referred to as a Skilled Nursing Facility – SNF) for further treatment.

Great! You think help is on the way and of course, Medicare will cover the expenses for your rehabilitation. Right?

Not so fast!

In order for Medicare to cover the care that you would receive in a rehabilitation facility you must have a “qualifying” hospital stay and the all-important word here is “qualifying”. This is a critical thing to keep in mind and you should always ask your doctor if your stay in the hospital will be on an inpatient basis (considered a qualifying hospital stay) or are you there for “observation services” (considered an outpatient hospital stay).

You see many doctors order “observation services” to help them decide whether their patients need to be admitted to the hospital as an inpatient. During the time you are in the hospital, in a room, undergoing “observation services”, you are considered an outpatient and therefore cannot count this time towards the 3-day inpatient hospital stay required for Medicare to cover your rehabilitation expenses. Your doctor must write an order for you to be admitted to the hospital as an inpatient.

That’s right. You MUST be a hospital inpatient for 3 days in a row in order for Medicare to pay for your stay in rehabilitation. (This includes the day you were admitted as an inpatient but not counting the day of your discharge.)

Don’t get caught unaware. It can be a very costly oversight.

If you need further assistance in understanding your hospital status or Medicare regulations, don’t hesitate to contact us at (516) 528-0206.