The Medicare Part A 30-day, 60-Day Secret

This is a problem that comes up in nursing homes at times. 

You have a nursing home resident that goes home in the middle of their 100-day Medicare benefit period.  They get home, have a decline, and need to come back to you.  If they need skilled services within 30 days of the discharge from your facility, you can accept them back under Part A without a new 3-midnight hospital stay.

If they’ve stayed out of the skilled nursing home and hospital or had a “wellness period” of more than 60 days, you can take them back with a new 100-day Medicare Part A benefit period as long as they’ve had 3 midnights in the hospital.

But, what about those times when they’ve been gone more than 30 but less than 60 days? 

The fact that most nursing homes don’t realize is that the resident has remaining days left in the original benefit period.  If your resident discharged over 30 but less than 60 days ago, and they’ve been in the hospital for 3 midnights again, you can accept them back under Part A for the remaining unused days in their original Part A benefit period.  For example, if they originally discharged on Day 45, you’ve still got 55 skilled days left available, barring any swing bed time.

This may not be new to you, but to many, it’s completely unknown.  I’ve actually seen patients told they have to pay privately because they didn’t “qualify” for Medicare Part A anymore, when they still had days remaining.  Let’s not miss out on our Medicare admission because we don’t know the rules. 

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2 Responses to “The Medicare Part A 30-day, 60-Day Secret”

  • Dashae Hooper, LNHA on

    Under the 60 day break rule, does the resident have to have a new spell of illness or can it be for the same illness?

  • Mark on

    It can be the same type of illness which triggers a new benefit period after 60 days. For example, they break the other hip.

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