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A woman who requires extended care and rehabilitation services

In this interactive case study, you will learn about Hilda Smith, a woman who requires extended care and rehabilitation services due to a fall in her home. Completing this activity will help you apply what you've learned about financial management in a healthcare situation.

Instructions
Review Case Study #2: Finance and Reimbursement (below)
Use the template (attached) & the information from the case to answer the questions.
Case Study

Introduction
This case study follows Hilda Smith, a patient at an acute care hospital. As you watch her story unfold, think about how a case manager might incorporate a collaborative process that encompasses various areas of medical care to deliver a personal and tailored recovery plan.

Meet Hilda Smith
Hilda Smith, who had osteoporosis, sustained a hip fracture because of a fall in her home.

After 5 nights in an acute care hospital, she is admitted to an SNF where she spends 16 days for rehabilitation, nursing care, and assistance with activities of daily living. The resident is then discharged to her own home where a physical therapist from a home health agency comes in to train her to use a walker and build strength.

After being at home for 25 days, Hilda develops deep venous thrombosis (blood clot in a vein) in her thigh (related to her fall) and is admitted to the hospital, from where she is transferred to the same SNF after spending 2 nights in the hospital.

Conclusion
Write your answers in well-developed sentences or short paragraphs, using your own words.

As the case manager, how would you respond to the following questions?

Assuming that Hilda meets Medicare criteria for the services described here, how many days of SNF care is she entitled to during her most recent stay (assume that she qualifies for the full 100 days)?
How much in deductibles and copayments does Hilda have to pay? (For 2021, the Part A deductible was $1,484 and the daily copayment for SNF was $185.50.)

Full Answer Section

Deductible and Copayments:

Assuming Hilda meets the Medicare criteria and hasn't previously used any SNF days this benefit period, she would be responsible for the following:

Part A deductible:$1,484 (one-time payment for the first 60 days of any inpatient hospital or SNF stay combined)
SNF daily copayment:$185.50 x 16 days (copayment for the first 20 days covered by Medicare, but since she only stayed 16 days, only those days are counted) = $3,008

Therefore, if Hilda meets the Medicare criteria, she would be responsible for the $1,484 Part A deductible and $3,008 in copayments for her first SNF stay. It's important to note that this information is based on 2021 data. Medicare deductibles and copayments can change annually, so it's crucial to confirm the current figures with reliable sources like Medicare.gov or by contacting Hilda's insurance provider. Disclaimer: This analysis is for educational purposes only and does not constitute financial or medical advice. Please consult with a qualified healthcare professional and financial advisor for personalized guidance regarding Hilda's specific situation.

Sample Answer

Hilda Smith's SNF Care and Costs

1. Days of SNF Care:

Medicare covers a maximum of 100 days of skilled nursing facility (SNF) care per benefit period, with the first 20 days being covered in full. However, there are specific requirements for SNF coverage, including needing skilled nursing or therapy services daily and transitioning from a hospital stay.

Since Hilda spent 16 days in the SNF during her first stay, these days counted towards her 100-day benefit period.

After being readmitted to the hospital and then transferred back to the SNF, her second SNF stay is considered part of the same benefit period. Therefore, she is not entitled to any additional days of SNF care under her current benefit period.