Medicare Coverage
Most senior citizens find comfort in knowing that they have Medicare benefits, as typically, it is during our senior years when our need for healthcare services increases. The Medicare program, administered by the Center for Medicare Services, has over the years adopted very strict requirements to assure that healthcare providers are giving Medicare beneficiaries clear and consistent communication about services and coverage.
It is important for our patients to understand what their Medicare benefits may or may not include. For example, Medicare does not pay for nursing home care and has limits on what services are covered for hospital patients, based on medical necessity of acute care conditions. For these reasons, inpatients will learn more about their Medicare coverage from our case management team, composed of nurses, social workers, physicians, and other care givers. Our team will explain the various Medicare forms that we are required to present to patients at specified points during hospitalization.
St. Mary's has adopted policies and procedures to align with Medicare's regulations on hospitalization. This means that upon admission or in the event of extended hospital stays patients may be issued a denial of coverage if their condition does not meet Medicare approved criteria for hospitalization. There are specific regulations of admission criteria, continued hospitalization and tests/procedures that can be performed during hospital stays. If a patient's condition does not meet these criteria, it is possible that the patient may be denied coverage under Medicare. If a patient is denied coverage by Medicare for hospitalization, St. Mary's Healthcare Center's staff will work with patients and families to find other resources to provide the appropriate level of care.
The Mission of St. Mary's Healthcare Center and Catholic Health Initiatives is to nurture the healing ministry of the Church by bringing it new life, energy and viability in the 21st century. Fidelity to the gospel urges us to emphasize human dignity and social justice as we move toward the creation of healthier communities.
In working toward its Mission, St. Mary's Healthcare Center has taken its role as a charitable organization very seriously; however increases in charity care, uninsured care and bad debt expense make managing cost increases a growing challenge. In fact in 2008, St. Mary's gave over $100,000 each month in charity care to over 187 families in our service area, providing care to patients with a variety of social and personal needs. Our mission of healthcare ministry relies on the preservation of the Medicare program, since over 60% of our patients are Medicare beneficiaries. The simple demographics of an aging population in our service area mandate that we all be good stewards of our healthcare resources.
Our mission will not change. St. Mary's will not deny medical care to anyone, and will continue to care for those who need our services. In order to remain a strong institution with in the community, we must keep up with changes which shift the responsibility of payment in accordance with Medicare regulations.
