General FAQ
Upon admission, residents are evaluated by our nursing staff and therapy department. Residents/RP will be required to sign admissions paperwork. The first 72 hours may seem a little busier due to staff coming in to introduce themselves and/or complete their required evaluations.
- A nurse will complete a full body assessment, review any medications the physician has ordered, and attend to any medical needs.
- A CNA will obtain vital signs, orient the resident to the room, and put away personal belongings.
- Our therapy department will screen for all three therapy disciplines (PT, OT, and ST) to see what areas the resident may need help.
- Physical therapy (PT): Gait/Walking, Exercise to Improve Strength, and Balance/Endurance for improved mobility and activity tolerance.
- Occupational therapy (OT): Activities of Daily Living, Upper Extremity Strength and Range of Motion
- Speech therapy (ST): Swallowing and Dietary Consistency
A Care Plan is a meeting composed of facility staff and the resident and/or responsible party to discuss the resident’s progress and plan interventions to meet the resident’s medical, nursing, and psychological needs.
Yes! We most certainly accommodate any special dietary restrictions.
- Physical therapy (PT): is used to help individuals in recovery from injuries, disabilities, and physical impairments. It involves exercise, manual therapy, and other therapeutic interventions to restore physical function, mobility, and strength.
- Occupational therapy (OT): is used to help individuals perform daily activities. It involves the assessment of physical, cognitive, and psychosocial factors to promote independence and improve quality of life. OT utilizes a variety of interventions, such as exercise, adaptive equipment, and environmental modifications, to help individuals achieve their goals.
- Speech therapy (ST): is used to help treat speech, language, and communication disorders. Speech therapy uses exercises, communication strategies, and technology to help individuals improve their communication skills and ability to swallow. The goal of speech therapy is to help individuals communicate effectively.
We do have items such as toothbrushes, toothpaste, deodorant, shampoo, etc. However, these are standard items, so if the resident prefers something specific, it would be ideal for them to bring those with them.
Financial FAQ
Medicare
- Medicare is the federal health insurance plan for people who are 65 or older, are living with End-Stage Renal Disease (ESRD), or certain younger people with disabilities.
- Medicare is broken into 4 components:
- Medicare Part A covers care related services while in a hospital, skilled nursing facility, hospice, or some home health services.
- Medicare Part B covers certain physician services, outpatient care, medical supplies, and preventive services.
- Medicare Part C is a Medicare replacement or advantage plan and discussed more in the next section.
- Medicare Part D is prescription drug coverage.
Medicare is designated for the population aged 65 and older, or certain individuals with specific diagnoses. If you are 65 or older and have worked at least 10 years where you paid federal taxes, you might be eligible for premium-free Medicare.
- Medicare Part A covers up to 100 days of skilled nursing care in a skilled nursing facility (SNF). Coverage of 100 days is not automatic, and a person must qualify for skilled services to be covered. The first 20 days of skilled care will be covered at 100%, and if skilled services are needed beyond 20 days, Medicare cover all but the assigned daily coinsurance which changes annually. The remaining balance starting on day 21 is co-insurance and will either be considered private pay and be paid out-of-pocket or could be covered by a secondary insurance plan such as a Medicare Supplement policy or Medicaid. Not all Medicaid Programs cover the Medicare Part A coinsurance.
- It is important to understand your plan of care developed by the interdisciplinary team of clinicians at the SNF to plan for any expenses related to the stay. The Business Office Manager or designee will provide you with an explanation of your benefits available and we encourage you to confirm the findings, to include how many Medicare days are available
While living in a Nursing Facility, Medicare Advantage patients are able to disenroll from their Medicare Advantage plan, changing to traditional Medicare, by submitting a request to do so at any time during the year.
Medicare Advantage plans are designed by the Federal government to allow beneficiaries the opportunity to purchase their Medicare benefits from commercial insurance companies. The plans provide the same coverage as traditional Medicare Parts A and B, however, additional benefits are often offered.
Typically, with a Medicare Advantage plan there is a monthly premium due for the plan, and this premium can vary from one year to the next. You will be made aware of any changes to the Medicare Advantage plan you are enrolled in. Medicare Advantage plans also offer additional benefits from what traditional Medicare offers, such as dental, vision, and hearing benefits.
Medicare Advantage
Medicare Advantage plans are designed by the Federal government to allow beneficiaries the opportunity to purchase their Medicare benefits from commercial insurance companies. The plans provide the same coverage as traditional Medicare Parts A and B, however, additional benefits are often offered.
Typically, with a Medicare Advantage plan there is a monthly premium due for the plan, and this premium can vary from one year to the next. You will be made aware of any changes to the Medicare Advantage plan you are enrolled in. Medicare Advantage plans also offer additional benefits from what traditional Medicare offers, such as dental, vision, and hearing benefits.
It is important to review and understand the benefits included with the Medicare Advantage plan. Medicare Advantage plans are required to offer health benefits that meet or exceed the benefits offered by traditional Medicare, however, payment for these benefits may differ from traditional Medicare.
- When you enroll in a Medicare Advantage plan, it is important to understand any out-of-pocket payments and deductibles associated with each category of service. Upon enrollment, you will receive an Evidence of Coverage document which explains your plan benefits and costs. If you have already enrolled in a Medicare Advantage plan and would like help understanding the plan, please reach out to your Insurance carrier for specific benefit details and/or our Business Office Manager.
- It is important to understand that many Medicare Supplement plans do not coordinate with Medicare Advantage Plans and you may be responsible for co-payments.
Each year the federal government has an open enrollment period. During the open enrollment period you can elect to change your health insurance to traditional Medicare.
Medicaid
Medicaid provides health care coverage for people with low incomes. In a nursing facility, sometimes a person needs to “spend down” their assets before they can become eligible for health care coverage. If you are uncertain of your ability to qualify, please contact your local Department of Social Services who can answer questions and provide guidance. You may also contact our Business Office Manager for assistance and questions regarding eligibility.
- In general, you are eligible for Medicaid if your income is low and you meet NC state requirements and you match one of the following criteria:
- Over the age of 65 or a child under the age of 21
- Breast or cervical cancer diagnosis
- You require nursing home care (long-term care)
- You are blind or disabled
- Receive Medicare
- There are different ways to apply for Medicaid, and one of our representatives would be happy to assist you with this process. You can apply online, in person, over the phone, or by mail, email, fax, or drop off at your local Department of Social Services (DSS) office.
- There are no limitations on when you can apply for Medicaid throughout a calendar year, so there is no need to wait for an open enrollment period.
- There are eligibility guidelines that must be met for Medicaid approval. If you are unsure if you meet the eligibility requirements, please contact your local DSS or our Business Office Manager for further information.
- There are some limitations as to what is covered by Medicaid, however, generally Medicaid will cover the following services.
- Visiting a doctor or nurse for checkups, lab tests, exams, or treatment
- Prescription drugs
- X-rays
- Inpatient and outpatient hospital services
- Nursing facilities
- Emergency ambulance services
- Transportation services to get you to a doctor’s visit
- Medical equipment and supplies prescribed
- Home health services prescribed by your personal physician
- Hospice care
- Dental care
Upon admission, the Business Office Manager will go through a preliminary pending Medicaid questionnaire to help determine the next steps in the Medicaid application process. The facility will work closely with the Department of Social Services (DSS) to ensure all necessary documentation has been received. A designated person with access to bank statements, life insurance policies, and various other personal documentation will be needed to obtain approval.
If you are a Medicaid recipient and have been assigned a Patient Monthly Liability (PML), then you must pay this amount each month to the facility. To simplify things for you, we can apply for Representative Payee on your behalf, which will allow your Social Security Check to come to the facility. We will then pay your Patient Monthly Liability (PML) out of these funds and the remainder will be available to you at your request.
For the most up-to-date information on how to apply for Medicaid and to see eligibility requirements, please visit https://medicaid.ncdhhs.gov/apply
Private Insurance
A private health insurance policy is a policy purchased by a private or commercial insurance provider and not the federal or state government.
Maybe. Coverage and benefits with private health insurance vary. It is important to understand the benefits of your specific plan. Please reach out to the your Insurance provider or the facility’s Business Office Manager to review your specific coverage details.
No, a long-term care policy is a contract between the patient and the long-term care insurance. The long-term care policy will reimburse the beneficiary for any benefits available. Please contact your long-term care insurance carrier for details on how to file a claim.
- “Private Pay” indicates that a significant portion of the resident’s stay is paid for “out-of-pocket,” or without insurance.
- Generally, if someone pays for their stay with us out-of-pocket, payment is due at time of admission and on the 1st of each month thereafter.
- The daily rate for private pay covers the “rent” for the room as well as all meals provided by the facility. Medical supplies, transportation charges, pharmacy services, and any other additional charges will be billed privately and in addition to the room and board rate. Separate therapy services may be covered by insurance if it is available, however, it is advised that all residents understand the benefits offered by any insurance policies held.
General Admission, Insurance, & Payment Questions
Yes, at admission please bring any Power of Attorney documents, living wills, and insurance cards. We will make copies and file.
We will contact your primary and secondary insurance, if applicable, verify your specific benefits and provide you with a letter outlining your financial responsibility. If your insurance requires prior authorization for your stay, we will obtain it and keep you informed of any changes.
Out-of-network services generally come with higher out-of-pocket costs and copays. We will contact your insurance provider and inform you of the in- and out-of-network costs to allow you to make an informed decision where to receive your care.
Many insurances are accepted, and we contract with a variety of Insurance Plans such as Humana, UnitedHealthcare, BCBS, etc. Please contact us for further details so we can explain what benefits are available to you with your specific insurance plan.
Yes, the facility will submit claims to your insurance company and inform you of any co-payments, deductibles, or denials of payment.
We will make every effort to work with the insurance company to resolve the outstanding balance, however, if the insurance company continues to deny the claim, the balance may become your responsibility.
We send statements out on the 20th of each month.
Your payment balance is due on the first (1st) of each month.
This is possible, depending on your insurance and what services are rendered. You could receive separate bills from other providers who deliver care.
We will be glad to send a duplicate statement to a designated individual.
Please contact the facility’s Business Office Manager if there are questions about your bill. He/She will be glad to assist and provide explanations or more details.
You should contact the bank to determine if anyone else already has access. If no one else has access, you can file for Power of Attorney.
Yes, the Department of Social Services (DSS) does consider any existing insurance premiums when determining the Patient Monthly Liability. We can pay the insurance premium out of the available Social Security funds.
You can open a Resident Trust Account for spending money, beauty and barber charges or any other incidentals. Your loved one will have access to these funds during banking hours which are posted in the business office, as well as on the weekend. To open a Resident Trust Account, please contact the business office manager at the facility.
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