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Medicare Guidelines

Centers for Medicare and Medicaid Services (CMS)

All acute rehabilitation hospitals must follow admission criteria as determined by the Centers for Medicare and Medicaid Services (CMS). According to CMS rules, patients will benefit from acute rehabilitation if they meet the following admission criteria:

  • patient must be able to participate in and benefit from intensive rehabilitation three hours a day, five days a week.
  • patient requires two or more therapies: physical therapy, occupational therapy and/or speech therapy.
  • patient requires 24-hour medical/nursing care with daily oversight from a physiatrist.
  • patient requires capacity for functional improvement based on goals determined by clinical team.

MEDICARE PART A BENEFITS (Hospital Insurance Costs)

Part A Benefits for Hospital Stays

  • Medicare pays 100 percent for the first 60 hospital days.
  • Thirty co-insurance days and 60 life-time reserve days.
  • Patient is required to pay a deductible for each episode:
    • Days 1 – 60: $0 co-insurance for each benefit period. $1,316 deductible for each benefit period
    • Days 61 – 90: $329 per day co-payment
    • Days 91 and beyond: $658 per day co-payment
    • Episode ends after 60 days of being at home without an inpatient admission.
    • Beyond lifetime reserve days: all costs

Part A and Skilled Nursing Facilities

  • Three midnight stays in acute-care hospital to qualify.
  • Patient must have a skilled need and physician order.
  • Medicare covers 100 percent of first 20 days.
  • Patient has co-payment of $164.50 for days 21–100.
  • Eligible benefit is 100 days - based on medical necessity and skilled need.

Part A and Home Health

  • Medicare Part A pays 100 percent.
  • Patient must qualify as "home-bound."
  • Agency providing the service must be Medicare-certified.
  • Benefit requires physician prescription and physician involvement.
  • Pays 20 percent of Medicare allowance amount for durable medical equipment.

MEDICARE PART B BENEFITS

Medicare Part B Benefits

  • Covers 80 percent of eligible physician services, outpatient therapy/hospital services and durable medical equipment after deductible is met.
  • Annual cap of $1,920 for physical therapy and speech therapy combined; $1,920 for occupational therapy.
  • $134 in premiums each month
  • $183 deductible
  • 20 percent co-pay
  • Premium adjusts based on income

For more information on Marianjoy Rehabilitation Hospital acute rehabilitative care, call the Marianjoy Admissions Department at 630.909.8920. A Marianjoy Admissions representative will be available to explain the admissions process and help you schedule a tour.

Accreditations

CARFJoint Commission
Several Marianjoy Rehabilitation Hospital programs are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission.

 

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