Inpatient care in a skilled nursing facility (SNF) or acute rehabilitation care in an inpatient rehabilitation facility (IRF)
There are two different types of inpatient nursing and rehabilitation care that Medicare Part A covers, each under a different set of rules and limitations.
1. Skilled nursing facility (SNF)
Medicare Part A covers inpatient care in a skilled nursing facility under the following circumstances:
A patient’s stay must begin within 30 days of an inpatient hospital stay of at least three days.
The patient must need, and have a physician’s prescription for, daily skilled nursing care or physical rehabilitation.
Care must be in a Medicare-certified skilled nursing or rehabilitation facility.
Coverage lasts only while the patient’s condition is improving. Once the patient’s condition has stabilized, Medicare Part A will no longer cover inpatient care.
2. Inpatient rehabilitation facility (IRF)
Medicare Part A covers acute rehabilitation care in an inpatient rehabilitation facility under the following circumstances:
The patient must need, and a physician must prescribe, acute rehabilitation consisting of at least two different types of therapy (such as physical and speech therapy, or physical and occupational therapy).
The patient must need, and a physician must prescribe, at least three hours per day of rehabilitation therapy.
The patient must need to receive the care as an inpatient, as prescribed by a physician and justified by the facility on an ongoing basis.
Care must be in a Medicare-certified inpatient rehabilitation facility.
Coverage lasts only as long as the patient needs the qualifying level of care.
Note: There’s no requirement of a prior hospital stay in order to receive IRF coverage, but without prior hospitalization, Medicare is more likely to question the need for inpatient rehabilitation care (as opposed to receiving the care as an outpatient).