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Medicare and Skilled Nursing Facilities How to Determine Your Coverage Skilled nursing facilities (SNF) can cause much consternation for Medicare beneficiaries, who often find Medicare’s definitions and requirements for covering SNFs confusing. Medicare rules, protocols, and forms must be followed for beneficiaries to receive coverage for care at SNFs, and if these rules aren’t followed, coverage may be denied. When skilled nursing is prescribed, certain essential criteria must be met for this service to be covered by Medicare. If you or your doctor misunderstands any one of these criteria, your coverage may be jeopardized. One of the most important criteria that must be met for Medicare to cover a stay in an SNF is that the treatment the patient receives can only be provided by an SNF, which usually equates to full-time or five-days-a-week care. If the patient could otherwise receive the same kind of treatment with weekly appointments at a treatment center, Medicare will not pay for an SNF. Making this distinction isn’t always easy, and these insurance decisions can be — and often are — challenged. For example, I once had a client who’d had a knee replacement, which, even with complications, usually does not require admittance to an SNF because patients can complete follow-up physical therapy at a physical therapist’s office and do exercises on their own at home. But this situation was different because my client was living in a small apartment with lots of furniture, a pet, and a feeble husband, making her at risk for a fall. While my client was not very old, her knee was not recovering at the usual pace, so her doctor recommended skilled nursing care. But Medicare denied the prescription. When her family came to me with questions, I suggested that they explain the situation to the doctor in greater detail and with more urgency, communicating that she was a serious fall risk because of her living situation. Once the doctor sufficiently emphasized this in their notes to Medicare, Medicare understood that the work the
“Chris came prepared to our meeting, and he explained Medicare and the Medicare plans to my husband and me in layman’s terms.” - Dixie H.
Sesame Zucchini Noodles When you’re craving takeout but want to keep your dinner healthy and refreshing, reach for this comforting, flavorful recipe instead of the phone.
Ingredients
• 4 medium zucchini • Salt, to taste • 3 medjool dates, pitted and softened in warm water for 5 minutes • 3 1/2 tbsp creamy, unsweetened almond butter • 3 tbsp coconut aminos • 3 tbsp pure sesame oil • 3/4 tsp fresh ginger, grated
• 2 cloves garlic, chopped • 2 tbsp apple cider vinegar • 3 scallions, thinly sliced • 1/4 cup chopped almonds
Directions
patient had done would be undone if she fell at home because of a pet, her furniture, or a complication in assisting her husband. Finally, the request was approved. Skilled nursing is very expensive, and Medicare needs to understand the medical necessity of a prescription before it will provide coverage. However, once this need has been communicated effectively by your medical provider, coverage for an SNF may be possible.
1. If you have a spiralizer, use it to cut zucchini into noodles. Otherwise, use a peeler. Salt zucchini. Allow zucchini to “sweat” out water for 1 hour, wrap in a paper towel, and squeeze the water out. 2. In a food processor, blend dates with almond butter and aminos until smooth. 3. Add sesame oil, ginger, garlic, and vinegar and pulse until sauce is smooth. 4. In a pan, sauté zucchini noodles until heated and slightly softened. 5. Toss zucchini noodles with prepared sauce and top with scallions and almonds.
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