Resources for you to help your patients
How to Make a Referral for our services
Referrals accepted 24/7 by calling the center’s Admissions Director to initiate the process.
Helping patient’s understand their healthcare benefit
Medicare is a federal health insurance program for people 65 and over and certain disabled people under 65. It does not provide a comprehensive long term care component. Medicare covers only those skilled nursing facility services rendered to help a beneficiary recover from an acute illness or injury. Medicare is administered by the federal government's Centers for Medicare and Medicaid Services (CMS) and is divided into two parts: Hospital Insurance (Part A); and Medical Insurance (Part B). mymedicare.gov
Medicare Part A helps pay for hospital stays, skilled nursing center care, home health care and hospice care. In a skilled nursing center Medicare covers the costs of a semi-private room, skilled clinical care, rehabilitation services, meals and other necessary skilled services and or supplies related to the patient need. A patient must have a qualifying 3 night hospital stay prior to an admission to the skilled center in order to access the benefit. Medicare pays for 110 percent of days 1-20 of a skilled nursing stay, but there is a co-insurance charge for days 21-100.
Medicare Part B helps pay for physician services, medical supplies that are medically necessary and out patient care that can include rehabilitation and some home health care services.
Medicare Part C is Medicare's Managed Care benefit. A Medicare beneficiary may enroll in a Medicare Advantage Plan and receive benefits through that plan, forgoing traditional Medicare. Different rules may apply through the Advantage benefits.
Medicare Part D is Medicare's Prescription Drug coverage. It provides coverage for your prescription drug costs. You must choose a plan to receive this benefit. The cost and coverage vary based on your prescriptions and the plans.
The Medicaid program is a joint federal-state program designed to provide health care assistance to low income people. Eligibility for Medicaid is made by the government based on certain criteria, such as a very low number of resources. The Medicaid health care benefits cover a patient's room and board, general nursing and therapy services, clinical supplies and medications. It does not cover personal care/comfort items; however a monthly allowance for such items is provided under the benefit. The government will look at all of your income, assets and resources when determining your eligibility, and come up with an amount that it believes you should be able to contribute to your care on a monthly basis. This "personal liability amount" is then deducted from the payments that Medicaid pays to a nursing center. You will be responsible for paying the personal liability amount each month. communityportal.fcdjfs.franklincountyohio.gov/Home/
Helping patient’s organize medical bills
Organizing Medical Bills
- Separate the bills by the provider of service name.
- Place the oldest statement date on the bottom and the most current date on the top.
- Next, sort the EOMB's (explanation of medical benefits) by provider of service and total amount charged.
- Place the oldest service date on the bottom and the most current on the top.
- If you have a supplemental insurance, sort the explanation on the bottom and the most current on the top.
Now you are ready to match the provider statement with the insurance payment statements (explanation of benefits forms)
Take the provider bill and look for the service date and the amount of the charge. Next, look at the stack of (EOB's) payment statements, and then the supplemental EOB's. Place the provider bill on top, then the Insurance payment statement second, and then the supplemental explanation of benefits form last. Proceed with the rest of the provider bills, and follow the same format. Place any duplicates in a separate stack to be disposed of later.
Organizing hospital, physician and other medical bills
After a hospital stay, a visit to your doctor, or skilled nursing facility stay, you may receive many different documents. It is very important to keep these medical bills, payment statements, receipts, prescription information, and claim forms together and in order.
Here are some basic tips that will help you organize this important information.
- Always ask whether a Provider (Hospital, Physician, Home care service, etc.) will bill all of your insurance directly on your behalf, also, if they accept Medicare assignment.
Even if they agree to bill your insurances, you will regularly receive bills, statements, and explanation of benefits (EOB) forms (response of the insurance company determination)
If the provider will not bill your insurance, you will then be required to submit the bill yourself, or have someone assist you in filing with your insurance company.
- Obtain a large accordion folder with several pockets in which to keep all of your paperwork. Several plain folders will also work. You will need to label the pockets or individual folder for the following:
- Each provider of service
- Prescription information
- Extra insurance forms
- Read each bill or statement carefully. Review the information. Look for:
- The name of the provider
- The address of the provider
- The account number
- The date of and charge for service
- The description of service
- Your name and, Medicare and/or insurance information
- The phone number to call with questions
Make sure you understand the bill. If you have any questions, call the number on the statement for clarification.
- Watching for the service date (the date you received the service) and the total amount of the charge will help you in sorting and organizing the documents related to each provider.
- Remember to look for the explanation of benefits (EOB) form first. This will state whether a charge was paid, denied, or if additional information is needed. If there is nothing for you to do, then file the form in the folder or divider assigned to that provider of service.
- If Insurance has paid on the claim, then the supplemental insurance can be billed. And, if the provider of service is handling this for you, then simply file the Insurance payment form in the correct provider folder or divider.
However, if you must file with your secondary insurance, then make a photocopy of the explanation of benefits (EOB) form and the provider bill. Print, on the copies, your supplemental identification number, then mail both, the explanation form and the itemized bill, if required, to the insurance company.
* Please note, some insurance companies require their own claim form also be included. If you have one of these companies, follow their procedure.
- As each provider charge is paid by your insurance, and there is no remaining balance, mark the bill as paid. File together the provider statement, the explanation of benefits (EOB) form, and the other insurance determination of benefits form, in the proper folder or divider.
- To keep track of all the payments, make a record of the information on a sheet of paper for easy review. Make a list of the following:
- Provider of service
- Account number
- Date of service
- Total charge for service
- Amount paid by Medicare
- Amount paid by insurance
- Payment you may have made