MEDICARE CONSULTING

Adults who are 65+ and who have an Original Medicare plan can receive 100 days of rehabilitation services in a Skilled Nursing Facility (SNF), if medically necessary and would receive Medicare Benefits to cover many of the costs of SNF services. Client's can engage the LEVY LAW & MEDIATION FIRM, P.C. when they are denied the 100 day benefit reimbursed by Medicare while receiving care in an SNF.
    The costs of such services are covered by Medicare as follows:

• Days 1-20; $0.00 for each benefit period
• Days 21-100; $185.50 (as of 2021) coinsurance per day of each benefit period.
• Days 101 and beyond; private pay (Approximate average daily rate typically $500-$600/day, plus physical therapy and occupational therapy at $150/hour)

     After admission to the SNF, at some point the Medicaid beneficiary's services will be reviewed by a Qualified Improvement Organization (QIO), which is conducted by a company named Livanta. After Livanta reviews the SNF's medical records that they submit to support denying the 100 day Medicare Benefits, a Notice of Non-coverage will be issued to inform the beneficiary of their right to Appeal and the reason for the Notice. The typical reason set forth on the Notice of Non-coverage is that the SNF concludes the beneficiary has plateaued. Once the Notice of Non-Coverage is issued, an immediate Appeal can be taken to reverse the adverse Decision.  The first level of Appeal is determined by Livanta. The benefits may be reinstated after the first Appeal is requested.  Medicare benefits are then typically reviewed again within 1-2 weeks, again by Livanta, who typically denies the benefits for a second time, at which point, a Second Appeal maybe taken. The first and second Appeal are done over the phone.  
     Following the second Notice of Non-coverage, the next step is to submit a formal Appeal to the NYS Office of Temporary Disability Assistance (OTDA). The FIRM can be engaged and retained to file an Appeal and draft documents in support of reinstatement of the Medicare benefits.
     Further, during this critical time, the FIRM can be engaged and retained to provide Long Term Care Consulting Services to assist in the decision process as follows:

• Advocate for the Client while admitted to the SNF to ensure they are not neglected and receiving required services.
• Assist the client to decide whether Chronic Care (nursing home care) or Community Medicaid is necessary.
• Locate professionals to provide necessary medical equipment for a safe return to home, make modifications to the home to accommodate a wheelchair and other necessary equipment for a safe return to home.
• Recommend Home Health Care Agencies that provide Medicaid licensed and qualified aides for care for the client, locate Assisted Living, Adult Living, Adult Day Care and Nursing Homes facilities to support the Client.