How Many Days Of SNF Care Is Hilda Entitled To And What Are

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.)

How Many Days of SNF Care is Hilda Entitled to and What Are Her Costs?

This case study examines Hilda Smith’s rehabilitation journey after a fall and subsequent hospitalizations, focusing on her entitlement to Skilled Nursing Facility (SNF) care under Medicare and the financial implications involved. To understand her coverage, it is essential to analyze the Medicare rules regarding SNF benefits, especially given her multiple hospital stays and rehabilitation periods.

Medicare Coverage for SNF Care

Medicare Part A covers skilled nursing facility care under specific conditions. Beneficiaries are entitled to up to 100 days of SNF care each benefit period, provided they meet the required criteria, including a qualifying hospital stay of at least three days (not counting the day of discharge). For Hilda, her initial 5-night hospital stay following her fall meets these criteria, allowing her to qualify for the full 100 days of SNF coverage. This entitlement resets with each new qualifying hospital stay within a 60-day period. However, subsequent hospitalizations, such as her 2-night stay with deep vein thrombosis, also trigger potential eligibility if they follow a qualifying hospitalization.

Application to Hilda’s Case

Given Hilda's clinical course, her second hospital stay due to DVT—spanning 2 days—is a qualifying hospitalization since it follows her previous stay within the same benefit period. Consequently, she is eligible to receive up to 100 days of SNF care during this recent period, assuming continuous eligibility and adherence to Medicare rules.

Financial Implications: Deductibles and Copayments

In 2021, Medicare Part A required a deductible of $1,484 for each benefit period. Once the deductible is paid, the first 20 days of SNF care are covered entirely, with no copayments for days 1–20. For days 21 through 100, a daily copayment applies, which was $185.50 per day in 2021. Therefore, if Hilda utilizes her full entitlement of 100 days, her costs will include the initial deductible plus copayments for days 21–100.

Calculating Her Potential Costs

• Deductible: $1,484 (paid at the start of the benefit period)
• Copayments: 80 days (from day 21 to day 100) x $185.50 = $14,840

Total costs, assuming she uses all 100 days, would amount to:

$1,484 (deductible) + $14,840 (copayments) = $16,324

Conclusion

Under Medicare rules, Hilda is entitled to up to 100 days of SNF care during her recent stay, assuming continued eligibility and a qualifying hospital stay preceding her transfer. Financially, she would have to pay a deductible of $1,484 and copayments totaling $14,840 if she utilized the full 100 days. Understanding these aspects is crucial for case managers to guide patients effectively through their rehabilitation journeys and financial planning.

References

• Centers for Medicare & Medicaid Services (CMS). (2021). Medicare General Information, Eligibility & Enrollment. https://www.cms.gov
• Medicare.gov. (2021). Skilled Nursing Facility (SNF) Benefits. https://www.medicare.gov
• U.S. Department of Health & Human Services. (2021). Medicare & You Handbook. https://www.medicare.gov/publications
• Hwang, U., et al. (2018). "Understanding Medicare and Long-term Care Policies." Journal of Aging & Social Policy, 30(4), 315-330.
• Smith, J. A., & Lee, R. K. (2020). "Financial Management Strategies in Healthcare." Health Economics Review, 10(1), 45-60.
• Kim, S., et al. (2019). "Costs and Benefits of Skilled Nursing Facility Care." Geriatrics & Gerontology International, 19(7), 695-702.
• Johnson, L., & Patel, R. (2017). "Rehabilitation Strategies for Elderly Patients." Rehabilitation Nursing, 42(3), 123-129.
• Williams, F., et al. (2015). "Medicare Coverage and Rehabilitation." Medical Care Research and Review, 72(5), 567-589.
• National Institute on Aging. (2020). "Understanding Medicare and Long-Term Care." https://www.nia.nih.gov
• American Geriatrics Society. (2019). "Guidelines for Post-Acute Care in Older Adults." JAGS, 67(4), 713-720.