Case Management

Tip: Determine patients' resources for postacute services

Case Management Weekly, April 13, 2011

Determining coverage for postacute services is a parallel discharge planning function that supports appropriate LOS. Understanding how Medicare pays for hospital services helps discharge planners counsel patients and document information that helps hospitals submit clean claims the first time.

When determining a patient’s resources for postacute care services, first verify that the patient signed a consent form allowing release of medical information to the payer(s). Then ask the patient’s insurer to determine which benefits are available to the patient. This is essential because resources the patient needs for continuing care extend beyond the hospital and affect the patient’s out-of-pocket expenses, copayment amount, or no-pay status. Many insurers have contracts with preferred providers; knowing with which providers primary payers have contracts also affects reimbursement for postacute care services.

This week’s tip is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace

Do you have a question about a case management topic? Send it to Associate Editor Ben Amirault at An answer to your question might appear in a future issue of Case Management Weekly.

Most Popular