Ask the Experts

Ask the expert: Medicare Part A coverage requirements

Q: A resident is under Medicare Part B coverage for therapy services and then during that time has a six night hospital qualifying stay; can they come back under Medicare Part A coverage? The last time they were under Part A coverage was in 2011.

A: Regardless of the Medicare patient’s payer source prior to the hospitalization, the Medicare Part A determination should be evaluated upon readmission to the facility. If the resident had a 60-day wellness period without receiving any skilled care after the last Medicare Part A stay in 2011, then the beneficiary should have a new 100 day stay available in the Common Working File after a 3-day qualifying stay and admitted within 30 days of the hospital stay.