MEDICARE PAYMENT POLICY

If a Resident is approved for Medicare benefits in a skilled nursing facility, the payments will be made as follows:

Day 1 through Day 20

Medicare pays the entire cost, including room, board, therapy services, medications, etc., provided the Resident has not been in any other skilled nursing facility for 60 days prior to admission; has had at least a three-night acute hospital stay; and maintains a need for skilled care.

Day 21 through Day 100

Medicare pays all but a copayment of $119.00 per day. (the amount is set at the start of each year; it is $119 for 2006).  If the Resident has coverage under a Medigap insurance plan such as Blue Cross/Blue Shield-Medex, or has additional medical insurance such as AARP, Blue Cross/Blue Shield, John Hancock/GIC, etc., the copayment may be covered (if Medicare coverage is approved).  HMOs oftern require copayment for admission to a skilled nursing facility.

As a courtesy to the Resident, our Admissions Department will contact your insurance company to determine the available benefits and notify you. If appropriate, our Billing Department will process those charges. If no additional insurance exists, the copayment will be billed to the Resident/Responsible Party.

If the Resident is eligible to receive skilled nursing services under Title XVIII of the Social Security Act (Medicare), the Resident and Responsible Party must understand that such eligibility will continue only for a limited number of days.

Eligibility for Medicare coverage is determined by the Resident's ongoing need for skilled nursing services and progress in their rehabilitation program. Therefore, the number of days (up to a maximum of 100) the patient will be covered is always uncertain.

While the Resident remains eligible to receive Medicare benefits in the Nursing Center, the Nursing Center agrees to accept the reimbursement allowed under Title XVIII as payment for all covered services.

When Medicare eligibility of the Resident terminates for any reason,* as finally determined by the Social Security Administration or any duly authorized utilization review committee, the Resident and Responsible Party agree to pay the charges when then established by the Nursing Center.

*Written notification is given with the right to appeal.