The Business Office is located on the first floor of Carroll Manor for your convenience. We are here to assist you with financial concerns regarding your stay. The hours of operations are Monday through Friday from 9:00 a.m. to 5:00 p.m. If you have any questions and/or concerns, please feel free to contact us at (202) 269-7808.
Resident's Financial Responsibility
Medicare
I. Skilled Nursing Facility Care (SNF) :
1. After a hospital stay of at least three midnights, Medicare can cover up to 100 days of skilled nursing care IF the resident is identified as:
- A. Needing skilled care on a daily basis; and
- B. Being admitted to the nursing facility within 30 days of a hospital discharge (the hospital stay must be at least three midnights) and is admitted to a Medicare-certified bed; and
- C. Having the physician certify that the patient requires skilled nursing care in accordance to the Medicare criteria and
- D. Meeting the facility's admission criteria.
2. Medicare pays days 1-20 at 100%. For days 21-100, Medicare assesses a co-insurance of $124 per day (in 2007) and is payable by you or an entity other than Medicare Part A.
3. Some secondary carriers such as Blue Cross/Blue Shield (BCBS) Federal will pay for a portion of the co-insurance. Although benefits are subject to change, BCBS - Federal generally covers co-insurance days 21-30 during a benefit period. Any days above and beyond day 30 will be billable to the patient in the absence of another carrier. Please contact your carrier to verify your benefits. If you foresee a problem in paying the Medicare Part A co-insurance, please contact Carroll Manor's Business Office.
4. DC Medical Assistance will also cover all or a portion of the Medicare A
co-insurance for its qualifying recipients. If the Medicaid recipient is receiving
a monthly income (i.e. Social Security or a pension), Medicaid can assess a portion
of that income to be paid to the facility.
1. Medicare Part A will not pay for non-skilled care.
2. Medicare Part B will pay for 80% of the doctor's visits at the nursing home as well as therapies, diagnostic services and doctor's office visits for a non-skilled resident. The remaining 20% is considered co-insurance and payable by an entity other than Medicare.
3. There is a $131 deductible for Medicare Part B in 2007.
4. DC Medical Assistance will cover the 20% co-insurance and the Medicare deductible.
Carroll Manor contracts with several insurance carriers to provide skilled care. Benefits are determined at the time of admission and authorized by the insurance carrier. The patient's financial responsibility depends on the patient's individual benefits under their plan. We currently have contracts with BCBS, Aetna and MAMSI/Optimum Choice.
Medicaid
DC Medical Assistance (Medicaid) will pay for nursing facility care for qualifying residents. Recipients of DC Medicaid receiving a monthly income (i.e., Social Security or a pension, etc.) are allowed to keep $70.00 each month, and the remaining portion is to be paid to the facility. Allowances (or deductions in the amount owed to the facility on a monthly basis) can be made for a spouse in the community, health insurance premiums and, in some circumstances, rent for an apartment if a recipient is here for a short-term stay, has the intention of going home, and documentation of such can be obtained from the physician. Generally, allowances are not made for such things as utilities for an apartment, life insurance premiums or upkeep of a house or taxes. The Business Office will bill the resident or their legal representative the amount stated by Medicaid.
Monthly payments can come directly to Carroll Manor. Your bill will be paid automatically, and the $70 allowance will be maintained in an interest-bearing savings account, accessible by you or your authorized party, in the Business Office.
There are times when official notification from Medicaid does not come until after the benefits have begun. It should be noted that a resident's financial responsibility begins when Medicaid starts to pay, regardless of how much later the notification is received. Medicaid's coverage can be retroactive up to three months. If the coverage is retroactive three months, the patient's financial responsibility is retroactive for the same time frame.
Medicaid is responsible to pay for all charges in excess of the patient portion.
Carroll Manor does not contract with any long-term care insurance plans. The Business office will assist in submitting claims to your long-term insurance plan, but payment in full is due 10 days after the invoice is received, regardless of payments from the long-term care insurance plan.
Residents who do not qualify for skilled care or for DC Medicaid are considered private pay. Payment for the first 30 days of service is due before admission. After the first 30 days of service, bills are generated the first week of each month and payments in full are due 10 days after the bill is received. Payments may be made in person at Carroll Manor's Business Office or by mail.
