OpenPlacement Blog

What Social Workers and Discharge Planners Should Know About Medicare

Here's the understatement of the New Year: Medicare can be frustratingly complex for patients and discharge planners alike.  Nevertheless, it is critical for social workers and discharge planners to be in the know about the aspects of Medicare that directly affect their patients and care facilities.  We have compiled a list that, although not exhaustive, highlights some crucial information that discharge planners should be aware of.

  • Medicare penalizes hospitals with high readmission rates.  As we detailed in our blog last October, care facilities are forced to forfeit Medicare funding when readmissions are higher than average, with the worst offenders bearing the brunt of the burden.  Social workers and discharge planners can do their part to minimize readmissions by following discharge best practices.  We previously published a list of tips to get you started.

  • Facilities that participate in Medicare are required by law to provide patients with valid, written notice using the "IM," otherwise known as the Important Message from Medicare( notice).  This piece of documentation is intended to explain a patient's rights, and must be provided to the patient no more than two days before discharge.

  • Medicare's discharge planning requirements are under-utilized, but they're extremely important.  While the requirements are different for hospitals and other types of nursing facilities, they require discharge planning evaluation, discussion with the patient and the patient's representatives, and a full review of the discharge plan.  For more information, the Center for Medicare Advocacy offers a full checklist of the requirements.

  • In order to trigger Medicare benefits for a patient, a hospital or nursing home is required to admit the senior is an in-patient and hospitalized for three consecutive days.  Benefits don't kick in for the patient if he or she is kept simply on "observation" status.  Insurance coverage and Medicare eligibility are two of the most important factors of a discharge team to consider before making a recommendation.

  • Different facilities have different discharge guidelines.  This is a critical point for discharge planners or social workers who work in a variety of facilities, or those whose employment recently changed from one to another.  Skilled nursing facilities, hospitals, long-term acute care, and hospices are all treated differently under Medicare.

These tips all serve to underscore the fact that Medicare patients can, and often do, appeal decisions made by discharge planners.  Naturally, hospitals have a financial incentive to discharge Medicare patients as quickly as possible; however, proper patient care and communication ensure that a patient is not discharged before he or she has received the proper levels of care.  As a discharge planner, it is your job to notify your patients of their Medicare rights, and perhaps most importantly, to keep those lines of communication open - during and after a patient's stay.

About the Author

Christy Rakoczy has a JD from UCLA School of Law and an undergraduate degree in English Media and Communications from University of Rochester. Her career background includes teaching at the college level as well as working in the insurance and legal industries. She is currently a full-time writer who specializes in the legal, financial and healthcare sectors. Ms. Rakoczy writes online content as well as textbooks for adult learners.