Criteria For Short-Term Nursing Facility Reimbursement

Health & Medical Blog

If your elderly loved one participates in the Medicare program, he or she may need to meet certain criteria before short-term nursing facility services can be reimbursed. Most of the time, Medicare will only cover costs associated with skilled nursing services and not custodial care. Here are some of the criteria your loved one will need to meet before reimbursement can be considered for short-term nursing facility care.

Intravenous Antibiotic Therapy

If the physician has prescribed intravenous medications for your senior loved one, short-term nursing home care may be appropriate. Intravenous medications are typically administered and monitored by the registered nurse and are considered to be a skilled treatment.

Conversely, if your senior individual takes only oral medications, Medicare reimbursement would typically not be considered. Intravenous medications are usually administered for short periods of time.

Depending upon the type and severity of the infection, intravenous antibiotics may be administered from a couple of days to a couple of weeks. The patient's post-antibiotic status will also need to be monitored via blood work or microbiology cultures.

Stage III or IV Decubitus Ulcers

Pressure or decubitus ulcers are not uncommon in elderly individuals, especially those who have poor circulation, diabetes, or those who are bed bound. Decubitus ulcers are classified as Stage I, Stage II, Stage III, and Stage IV. A Stage I decubitus ulcer appears as redness on the superficial layer of the skin, while a Stage IV ulcer may involve underlying tissue such as the muscle, tendons, and bones.

If your senior loved one has a Stage III or Stage IV ulcer, Medicare may pay for the costs for treatment in a short-term facility, however, Stage I and Stage II ulcers are usually not reimbursable through government programs.

In addition to wound dressings and ointments, people who have severe pressure ulcers may also be on intravenous antibiotics to prevent cellulitis, a dangerous soft tissue infection that can develop as a result of deep pressure ulcers. 

If your senior loved one's physician recommends that he or she be admitted to a short term nursing facility for skilled nursing services or physical rehabilitation, talk to the financial director at the facility to determine reimbursement eligibility. In addition to pressure ulcer care and intravenous antibiotic therapy, physical, occupational, and speech therapies are also reimbursable through the Medicare program. These skilled therapy programs typically last for a couple of months, making a short-term nursing facility an appropriate placement option.


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