Was her hospitalization a qualifying event entitling her to skilled nursing facility coverage?
Medicare beneficiaries are entitled to medically necessary skilled nursing facility services for post-hospital care after a three-day prior hospitalization. However, if Medicare denied coverage for the hospital stay because, for example, it believed Ms. L could have been served on an outpatient basis, even the fact that Ms. L was in the hospital for four days would not make it a qualifying hospital stay. The prohibition against charging Medicare beneficiaries does not apply “where it is clear upon admission that payment under Medicare Part A cannot be made.” If the nursing facility knew that Medicare had denied payment for the hospital stay, it might be protected. 2. Is her receipt of skilled nursing facility services medically necessary? Aside from the question raised above about the qualifying hospital stay, if the skilled nursing facility determined that Medicare was not likely to cover Ms. Ls SNF stay because, for example, she does not need skilled nursing care, it might demand the
