Medicare and Medicaid
Explanation of Medicare
Daily need for a skilled service qualifies a patient to receive Medicare Part A coverage for up to 100 days for each spell of illness, as defined by a three day hospitalization. Medicare Part A is insurance coverage provided by the federal government. Patients are entitled to receive these benefits to restore their health or prevent a decline in their health.
Skilled care is defined as care on a daily basis, requiring the expertise of a skilled professional, such as a licensed therapist or registered nurse; or, a grouping of services requiring the supervision of a skilled professional. An attending physician must certify the skilled need.
The Medicare paying agent, also known as CMS (Centers for Medicare and Medicaid Services), does not pay for custodial care – care that can be given by an untrained person. The Social Security Administration is the governing body for insuring Medicare beneficiaries.
It is a cruel paradox that the federal government both provides these dollars for care and is also the choke point for their disbursement. At All-American Care, we do what is necessary to insure that each patient gets the appropriate benefit to restore their highest level of functioning. We do not discharge patients from the Medicare program based on an arbitrary number of 20 to 30 days or capricious rules of thumb. We discharge patients from the Medicare program when they have reached their improvement goals and no longer qualify for coverage.
All-American Care Customized Restorative Care Planning provides the information Medicare requires to approve appropriate rehabilitation and treatment. The computerized documentation gives CMS Fiscal Intermediaries all the information they need to reimburse patient care. In the unlikely event of a denial, All-American Care will appeal the patient’s denied coverage utilizing the legal and administrative procedures.
The All-American Care Package ensures that all qualified Medicare coverage is provided.
All-American Care -- Our success is measured by our patients’ “Quality of Life”
Explanation of Medicaid
Medicaid provides personal care services and also pays for low level restorative care. Custodial care is defined as care that can be given by an untrained person. Most states only pay for personal care services. Medicaid is administered by each individual state and is based on revenue sharing that the individual states receive from the Federal Government.
Medicaid is a payer of last resort. In other words, Medicaid pays the bill when all other sources, including your own funds, are exhausted. Using your own funds is referred to as “spend down” because each State requires that your assets be spent down to a particular level before a patient qualifies for Medicaid coverage. This level differs for each State.