Do you wish you had a nickel for every family member who said, “The Doctor said Medicare would pay for everything.”?  

If only that was true.  Prospective residents and family members are often in a whirlwind of emotion and confusion when contemplating Post-Acute care options.  Between trying to visit someone in the hospital, pay attention to the recommendations of professional caregivers, consider choices to be made and then remembering to pick up ‘Jimmy’ after soccer practice, it can be just too much.  In the end, some physicians may be under the misconception that Medicare pays for everything and when that is communicated to the family, it creates an expectation that may not be realistic.  

Best Practices for Talking to Families About Payment for SNF Care

To truly help your prospective residents and their family members understand how payment may work, consider these best practices:

Be sure to either obtain copies of all relevant beneficiary cards for any payers or use a software or online service to verify eligibility and benefits prior to admission/intake.  

Explain the difference between Medicare and Medicaid.  These terms are often confused and confusing.

Explain that Medicare works this way:

Medicare is a federal program.  It is for individuals who are over age 65 or who may meet other special eligibility guidelines.  You should know if the prospective resident may be eligible due to one of these special situations such as ESRD or as a covered dependent, etc.

Medicare provides for care in a SNF for up to 100 days.   The first 20 days are covered fully. The remaining 80 have an amount known as co-insurance.  Explain the amount for the current year.

One of the forms that must be signed as part of the admissions process is permission for treatment and it permits the facility to bill on behalf of the resident.  Explain that it is not a guarantee of payment.  However, based on the information that the facility received from the hospital, you would anticipate that the care would be paid for.

Explain that Medicaid works this way:

Medicaid is a federal program.  It is administered by each state.  In order to qualify for benefits under the Medicaid program, a person must complete an application and submit documentation substantiating the answers to the questions on the application.  The application will be reviewed locally and the review will include a “look back” over bank records, financial transactions, medical expenses, etc. during the previous five-year period.

Explain that LTC insurance works this way:

Beneficiaries may be asked to pay privately for services provided and then submit an itemized bill to the insurance carrier for review.  Care may need to meet specific criteria of the carrier and may require medical documentation which your community will be happy to provide as requested.

Provide a business card and contact information for the person on your staff who can answer questions.  This may be an admissions rep, business office rep or social worker, etc.  Invite questions.

Offer an explanation of the payment terms of the community.  These may also be outlined in the Admissions Agreement.  It can be very helpful for the Business Office rep to explain these personally at the time of admission.

Charges for care are submitted to payers (insurance companies) on behalf of the resident.

Payment is not guaranteed by the insurance carriers.  All charges are the responsibility of the resident/responsible party.

Charges are billed once per month. Payments are expected by the X day each month, typically the 5th business day.

Payments may be made by check, cash, credit cards, etc. and provide information as to how the payments may be made… at the front desk, online, etc.

Charges to Medicare Part A include room and board, medications, therapies, etc.  Any charges due by the resident/responsible party will be billed separately and identified as co-insurance, incidentals, etc.

Provide any assistance possible with applications such as:

Offer to make copies of cards, bank statements, etc. without charge

Offer to help complete forms.  Some of your residents and family members may have educational or visual issues that make it more difficult.

Offer to become a representative in the process.  Can you help to make a phone call to an insurance carrier with the family member?  Can you become the authorized representative for the Medicaid application process?  

Offer to send duplicate invoices, completed forms, etc. to third party payers as required as part of their contract with your residents.  This is particularly important for LTC insurance which may require the resident to pay privately first and then become reimbursed.

Can you schedule a regular forum to share information with prospective residents and family members?

Sponsor an “Information Night” and invite local speakers to talk about payment options for Post-Acute care options.  Your local Office on Aging, Senior Center, Hospital Case Management program, etc. should be able to help find a great speaker.

Include a little blurb in every newsletter….” Need more information about paying for care?  See Suzie in the Business Office.”  You can include similar information in your Welcome packet or on signage near your Bulletin Board.

When meeting with residents and family members as part of the Admissions/intake process, explain that your community wants to do everything possible to help obtain any possible benefits for which the resident may be entitled.  In order to do that, you may ask for certain information, such as insurance cards, copy of policy, etc.  Sometimes family members view the process as intrusive.  They are guarded about discussion of financial matters.  Assure them that you want to help them obtain any benefits and information that will help them obtain any available payment for care.

In summary, prospective residents and family members may be overwhelmed by the fast paced discussions regarding care needs and payment requirements for Post-Acute care.  The role of the community staff is to assure all parties that you are there to help determine eligibility, assist with the application process as necessary and support the resident and family in obtaining any benefits available. Families should understand the payment terms of the community and know that if they have a question, there is a listening ear available to help.

For more information about talking to families about payment options, Contact Richter Healthcare Consultants at 866.806.0799.