Kotelemela Lopitalo oyo ezali na bokengi te to ya liboso ya ntango to kobima na lopitalo ya Rehab mpo na Mobange¶

Lopitalo mpe bisika ya ba infirmiers oyo bayebi mosala malamu (SNF) esalaka na nse ya mpasi makasi ya mosolo mpe ya makoki ya mbeto mpo na kosala ete ntango molai ya mobeli ya kofanda mokuse. Mbala mingi bapesaka mabota mikanda ya kobimisama na lopitalo na mwa bangonga mpamba ya koyebisa, ata ntango mokóló oyo akómi mokóló akoki naino kotɛlɛma te kozanga lisalisi, atikali kobulungana makasi, azali kosɛnga bankisi oyo ekɔtisami na misisa, to azali na mobateli ya libateli te na ndako. Komema ndako ya mibange oyo ezali stable na médecine to oyo azali kosala mosala te na motuka ya moto ye moko mpo ete mokambi ya makambo ya lopitalo alobi ete ntango ya assurance esili ezali moko ya bantina ya liboso ya kokweya ya mpasi, pneumonie ya aspiration, mabunga ya nkisi, mpe kozongisama na ndako ya lisalisi ya nokinoki na boumeli ya ngonga 48.

Ozali na makoki ya mibeko oyo ekoki kosalelama na Etats-Unis, Royaume-Uni, Canada, Australie, mpe na Union européenne mobimba mpo na kopekisa kobima na lopitalo liboso ya ntango mpe kotinda na makasi botali ya clinique ya lipanda yambo mobɛli abima na ndako. Soki otiki molingami na yo na baporte ya lopitalo mpe otye sinyatili na mokanda ya bokundoli ya kobima na lopitalo, bokonzi na yo ya mibeko mpe libateli na yo ya séjour ya assurance automatique elimwaka. Na kobatelaka mobɛli na mbeto mpe kobenga mibeko ya recours officiel ya kobimisama na lopitalo na esika yango, ozali kotinda esika yango ebatela lisalisi ya monganga mobimba ntango minganga ya libándá bazali kotala etanda to ntango babongisami mpo na kozongisa mobɛli oyo azali na lopitalo na lopitalo na ndenge ya libateli.

Sala boye sikoyo¶

1. Koboya kotia sinyatili na mikanda ya bolongoli to komema mobeli na ndako. Yebisa infirmier, monganga, mpe mobongisi ya bolongoli na kimia mpe na polele: "Kolongolama oyo esengami ezali na likama te. Tozali na formation ya monganga te, makasi ya nzoto, to bisaleli te mpo na kobatela mobeli oyo na bokengi na ndako, mpe tokozwa bango lelo te." Soki mobɛli azali sikawa kokutana na mpasi ya monganga oyo ezali kotya bomoi na ye na likama oyo basali bazali koboya kotala, benga Equipe ya réponse rapide ya kati ya lopitalo to benga nimero ya urgence ya esika ofandi (911 na Etats-Unis mpe Canada, 112 na Union européenne mobimba, 999 na Royaume-Uni) to tala banimero ya mbalakaka.
2. Senga liyebisi ya mokanda ya makoki ya recours ya bolongoli mbala moko. Na Etats-Unis, mobɛli nyonso ya Medicare mpe Medicare Advantage asengeli kozwa formulaire officiel oyo ezali na motó ya likambo Nsango ya ntina uta na Medicare (Formulaire CMS-10065) na lopitalo to Liyebisi ya Medicare Non-Coverage (Formulaire CMS-10123) na esika ya infirmier ya mayele liboso ya kobima na lopitalo.
3. Benga agence indépendante ya recours yambo ya mokolo ya suka oyo epesameli na mibeko. Na Etats-Unis, benga nimero ya telefone ya Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) oyo enyatami na liyebisi yambo ya minuit na mokolo ya kobima na lopitalo (to na midi mokolo yambo ete couverture ya rehab esila). Na Royaume-Uni, benga Service ya Conseil et liaison ya ba malades (PALS) mpe Matron ya quartier; na Canada, benga Mobateli ya bato ya maladi ya lopitalo.
4. Kotingama na botali lisusu ya Thérapie Physique mpe Thérapie Occupational ya mokolo moko. Senga monganga oyo azali kotala ye apesa mitindo ya botalisi ya mosala ya Thérapie physique (PT) mpe Thérapie Occupational (OT) pembeni ya mbeto oyo etali botiami ya kofanda na kotelema, ntaka ya kotambola, komata na eskalye, mpe botiami na twalɛti. Soki PT to OT ekomi ete mobɛli asengeli na lisalisi ya bato mibale to akoki kosalela eskalye ya kokɔta na ndako te, kobimisama na ndako ezali na ndenge ya clinique te.
5. Kotala état ya boyambi ya mobeli (Mobɛli oyo azali na lopitalo vs. Observation). Soki moboti na yo azali na lopitalo ya Etats-Unis na se ya Traditional Medicare, tuna mokambi ya likambo soki ba classer bango lokola "Mobɛli oyo azali na lopitalo" to "Observation ambulatoire." Soki babombami na se ya statut ya Observation mikolo ebele, senga botali ya mbala moko na comité ya Revue ya Utilisation ya lopitalo mpo na kobongola séjour na Inpatient yambo ya kobima na lopitalo mpo ete couverture ya Skilled Nursing Facility (SNF) e déclenché.
6. Tia botelemeli na yo ya bokengi na dossier médical ya libela. Tinda nsango mokuse, ya solo na nzela ya portail électronique ya mobeli (lokola MyChart) to pesa mokanda oyo ekomami na Infirmier ya Charge mpe Mokambi ya Cas oyo ezali kotanga barrière nionso ya sikisiki ya mosala mpe ya monganga mpo na kozonga ndako.

flowchart TD
    A["Lopitalo to rehab esakoli kobima imminente ya senior instable"] --> B{"Mobange akoki kokende na esika mosusu, kokende na twalɛti, komela, mpe kotambwisa yango na ndako na ndenge ya libateli?"}
    B -->|"Oui: Baseline ezongisami mpe bisaleli ebongami"| C["Kosilisa boyokani ya nkisi mpe kosala programme ya bolandi ya mikolo 7"]
    B -->|"Te: Ezali na likama te mpo na kozonga na ndako"| D["Koboya kotia sinyatili na mikanda ya bolongoli to komema mobeli"]
    D --> E{"Lolenge nini ya esika mpe système ya santé?"}
    E -->|"Lopitalo ya États-Unis (Medicare to Medicare Advantage) ."| F["Bosenga Nsango ya ntina uta na Medicare (CMS-10065)"]
    E -->|"Infirmier ya mayele ya Etats-Unis / Rehab (SNF) ."| G["Liyebisi ya bosenga ya bozangisi ya Medicare (CMS-10123) ."]
    E -->|"UK NHS / Canada / Australie / Assurance privée"| H["Dossier officielle hold na PALS, Ombudsman ya ba malades, to Utilization Review"]
    F --> I["Benga BFCC-QIO (Acentra to Livanta) yambo ya minuit na mokolo ya bobimisi"]
    G --> J["Benga BFCC-QIO na midi mokolo moko yambo ete couverture esila"]
    I --> K["Séjour automatique déclenché: Lopitalo ekoki te kobengana to kofuta na poche na tango ya botali"]
    J --> K
    H --> L["Bosenga PT/OT audit ya escalier na transfert plus conférence ya soins multidisciplinaires"]
    K --> L

Koyeba ntango nini kobima na lopitalo to na rehab ezali na likama te na clinique¶

Mbala mingi, baye basalaka plan ya kobima na lopitalo batalelaka stabilisation médicale ya diagnostic ya admission primaire lokola esenge se moko mpo na kotinda mokóló ya mokóló na ndako. Monganga akoki komona ete bokono ya ntolo ya mobɛli ezali kobonga na bankisi oyo ebomaka mikrobe oyo emɛlaka to ete esika oyo bakati ye na lipaso ezali komonana pɛto, nzokande azali mpenza kotalela likambo oyo ete mikolo mitano ya kolala na mbeto etiki mobɛli ya mbula 82 akoki kotɛlɛma te na twalɛti to kozala mosika na yango délirium ya lopitalo mpe mobulungano ya mbalakaka.

Yambo ya kondima mokolo nyonso ya kobima na lopitalo, talela mobɛli na kati ya ba domaines motoba ya sécurité clinique mpe fonctionnelle objective. Soki mobɛli alongi te ata moko ya makambo yango mpe esika yango ebongisaki te lisalisi ya ngonga 24 na bisika oyo basalisaka bato to infirmier professionnel na ndako oyo ezali kokoba, kobimisama na lopitalo ezali na likama te.

How to file an immediate Medicare hospital discharge appeal (United States)¶

In the United States, federal law (42 CFR Part 405, Subpart J) grants every beneficiary covered by Original Medicare or a private Medicare Advantage plan the right to an expedited, independent medical review before being discharged from an inpatient hospital stay.

Step 1: Demand "An Important Message from Medicare" (Form CMS-10065)¶

Hospitals must deliver the two-page federal notice titled An Important Message from Medicare About Your Rights (Form CMS-10065) twice during every inpatient stay: within 2 calendar days of admission, and again between 4 and 48 hours before discharge.

Signing Form CMS-10065 does not mean you agree that the patient is ready to go home; it merely acknowledges receipt of the appeal phone number. If the hospital tells you verbally that your parent is being discharged today without handing you the second copy of Form CMS-10065 listing the BFCC-QIO phone number, tell the case manager: "You have not delivered a valid final Important Message from Medicare. Under CMS rules, this discharge cannot proceed until the written notice is served."

Step 2: Call the BFCC-QIO before midnight on the day of discharge¶

Medicare contracts with independent physician review bodies called Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) to handle rapid discharge appeals: Acentra Health and Livanta. Your state's toll-free QIO number is printed on Page 1 of Form CMS-10065 (or call 1-800-MEDICARE at 1-800-633-4227).

• Mokolo ya suka ya minuit ya critique: Benga BFCC-QIO yambo ya minuit (23:59 PM) na mokolo oyo esengelaki kobima na lopitalo mpe yambo ya mobeli abima na ndako.
• 24/7 Motango ya bopanzi sango ya mongongo mpe ya botiami na nzela ya internet: Ba lignes ya boyambi ya BFCC-QIO esalaka 24/7. Kotika mokanda ya mongongo to boyambi na nzela ya internet yambo ya minuit na kombo ya mobeli, nimero ya Medicare, nkombo ya lopitalo, mpe nimero na yo ya kobenga lisusu ekangamaka na mibeko na recours na ngonga. Kokoma elembo ya ngonga mpe nimero ya bondimi.

Etape 3: Kososola séjour automatique ya décharge mpe protection financière¶

Kosala recours na tango esengeli liboso ya minuit e déclenchaka séjour automatique ya décharge: 1. Lopitalo ekoki te kotinda mobɛli na makasi abima: Mbeto ya mobeli mobimba, bobateli ya infirmier, mpe lisalisi ya monganga esengeli kokoba na tango ya botali QIO. 2. Zéro responsabilité ya mbeto ya poche na tango ya recours: Lopitalo ekoki te kofuta mobeli na poche ya mikolo ya kobakisa ya mobeli tango minganga ya QIO bazali kotala tableau, ata soki QIO eboyi na suka recours na yo. 3. Liyebisi ya bozindo ya bolongwi (CMS-10066): Soki osali recours, lopitalo esengeli kopesa liyebisi na mokanda kino na midi ya mokolo molandi oyo elakisaka bantina ya sikisiki ya kliniki oyo bakanisaka ete bobateli ya lopitalo ya aigu ezali lisusu na ntina te.

Etape 4: Salá likambo na yo ya clinique mbala moko epai ya motali ya QIO¶

Ntango BFCC-QIO ebengi yo lisusu (na kati ya ngonga 12 kino 24), loba makambo ya sikisiki ya kliniki uta na etanda oyo ezali kolakisa instabilité médicale to bamposa ya transition oyo ezali na bokengi te: - "Mobɛli azwaki délirium hypoactif aiguë eleki ngonga 48, atikali na nse ya base cognitive, mpe asɛka ntango azali komela mai." - "Thérapie physique ekomaki lobi ete mobeli asengeli na assist ya 2 Personnes mpo na ko transferer mpe akoki te komata na ba 6 escaliers na ndako na bango." - "Mobɛli alongwaki na nkisi ya kokɔtisa misisa mpe ya komela kaka ngonga 3 mileki, mpe stabilité ya ngonga 24 e vérifié te." - "Mobɛli asengeli kokende na esika ya infirmier ya mayele (SNF) oyo azali na lopitalo, mpe bokambi ya makambo ezwi mbeto ya kondima te."

Etape ya 5 : Nini esalemaka tango QIO ebimisaka mokano na yango¶

BFCC-QIO esengeli kotala mikanda ya monganga mpe kobimisa mokano na kati ya ngonga 24 nsima ya kozwa dossier ya lopitalo. - Recours endimami: Liyebisi ya bolongoli elongolami mpe bobateli ya Medicare ekobi kino mobeli ako stabiliser to ako transferer na bozangi likama. - Appel eboyami: Ozali na nyongo te mpo na ngonga 24 kino 48 ya botali. Mokumba ya libanda ya poche ebandi na ngonga ya 12:00 ya midi na mokolo ya manaka NSIMA ya QIO koyebisa yo bowangani. Kosala recours ezali kaka ko assurer 36 à 48 heures couvertes pona kobongisa ba équipements ya ndaku to placement ya rehab, pe epesi nzela na demande ya mbala moko Niveau 2 Reconsideration na Contracteur indépendant qualifié (QIC).

Motambo ya Medicare "Ezalela ya botali" vs. "Ezalela ya mobeli ya lopitalo".¶

Mbala mingi likambo ya mpasi ya mosolo mpo na mikóló oyo bakómi mibange na États-Unis ezali Mobeko ya Medicare Three-Midnight Inpatient Rule mpe "Ezalela ya botali ya mobeli ya libanda." Mobange akoki kokoma na ambulance, kozwa shambre ya lopitalo ya likolo, kozwa nkisi ya IV, mpe kotikala butu minei ntango azali kotángama na ordinatɛrɛ ya kofuta mbongo lokola Moto oyo azali na maladi ya libanda oyo azali kozwa Misala ya kotala na esika ya kozala andimaki Mobɛli oyo azali na lopitalo.

Mpo na nini état ya Observation e bloquer couverture ya rehab ya Facilité ya Infirmier Skilled (SNF).¶

Na se ya Medicare ya bonkoko Eteni A, Medicare efutaka kaka mpo na bozongisi ya sima ya lopitalo ya Skilled Nursing Facility (SNF) soki mobɛli ayambamaki na ndenge ya mibeko lokola Mobɛli oyo azali na lopitalo mpo na ata midi ya butu misato oyo elandana (kolongola bangonga ya salle d’urgence mpe minuit ya Observation). Kolekisa 2 minuit na Observation mpe 1 minuit lokola Inpatient epesaka zéro ya couverture ya Traditional Medicare mpo na SNF rehab, ko exposer mabota na ba demandes ya lifuti ya privé ya 400 à 700 dollars na mokolo.

flowchart TD
    A["Mokóló oyo batye na mbeto ya lopitalo na salle ya minganga"] --> B["Tuna infirmier to mokambi ya cas na Mokolo ya 1: Est-ce que statut ezali Observation Formelle ya Maladi ya Lopitalo to ya Ambulatoire?"]
    B -->|"Ezalela ya mobeli ya lopitalo ya officiel"| C["Tanga minuit oyo elandi sima ya ordre officiel ya admission ya maladi na lopitalo"]
    B -->|"Ezalela ya Observation ya Ambulatoire"| D{"Mobɛli azali na lopitalo koleka ngonga 24?"}
    C --> E{"Au moins 3 minuits ya Inpatient consécutifs?"}
    E -->|"Ɛɛ"| F["Azali na makoki ya kozwa rehab ya Traditional Medicare Part A Facility ya infirmier ya mayele (SNF)."]
    E -->|"Te"| G["Senga monganga mpe Utilization Review mpo na prolongation ya séjour ya Inpatient soki cliniquement instable"]
    D -->|"Ɛɛ: Koleka ngonga 24"| H["Formulaire ya Demand MOON (Avis ya observation ya ba ambulatoires ya Medicare) ."]
    H --> I["Senga Monganga oyo azali kotala a contacter Utilization Review mpo na kobongwana na Inpatient na se ya Mibeko ya Mibale ya Midi ya butu"]
    I --> J{"Mobɛli azali na Medicare Advantage to Original Medicare?"}
    J -->|"Litomba ya Medicare"| K["Tala soki plan elongoli mobeko ya mikolo 3 ya mobeli ya lopitalo mpo na rehab ya SNF na kati ya réseau"]
    J -->|"Medicare ya ebandeli"| L["Kosala recours retroactif to ya mbangu na se ya mibeko ya Alexander v. Azar soki ebombami na Observation mikolo 3+"]

Ndenge nini kosala audit mpe ko challenger état ya Observation avant ya kobima na lopitalo¶

1. Tuna motuna ya ezalela ntongo nyonso: Kondimisa mokolo na mokolo na monganga oyo azali kotala ye mpe mokambi ya likambo soki mobeli azali na nse ya motindo ya mobeli ya momesano to Observation ya Ambulatoire.
2. Watch for the MOON form (CMS-10495): Hospitals keeping a Medicare patient in Observation for over 24 hours must deliver the Medicare Outpatient Observation Notice (MOON) within 36 hours.
3. Invoke the CMS Two-Midnight Rule with Utilization Review: Under the CMS Two-Midnight Rule, if the physician expects the patient to require hospital care across at least two midnights, Inpatient admission is appropriate. Ask the Attending Physician and Utilization Review (UR) Physician Advisor for an immediate Condition Code 44 review to convert Observation status to formal Inpatient before discharge.
4. Use the Alexander v. Azar (CMS-4204-F) Observation Appeal Right: Medicare beneficiaries reclassified from Inpatient to Observation (or kept in hospital 3+ days without Part A SNF coverage) have federal administrative appeal rights through the QIO.
5. Check Medicare Advantage 3-Day Rule Waivers: Over 80 percent of private Medicare Advantage (Part C) plans waive the 3-day inpatient stay requirement and authorize direct transfers to in-network SNF rehab.

Stopping a premature discharge from a Skilled Nursing Facility (SNF) or rehab center¶

Around Day 10 to Day 21 in a Skilled Nursing Facility (SNF), families are often told: "Medicare only pays for 20 days, or your parent has plateaued in physical therapy, so coverage ends in 48 hours." Both claims are frequently false under federal Medicare law.

Myth 1: "Medicare only covers 20 days of rehab"¶

Medicare Part A covers up to 100 days of Skilled Nursing Facility care per benefit period as long as the patient requires daily skilled nursing or skilled rehabilitation therapy (PT, OT, or Speech Therapy at least 5 days a week). Days 1 to 20 carry a $0 copay, while Days 21 to 100 carry a daily statutory coinsurance (covered in full by Medigap Plans G or F, or Medicaid). Because reimbursement tapers after three weeks, facilities often pressure families to exit early despite ongoing skilled needs.

Myth 2: "We are discharging your parent because they have plateaued" (The Jimmo v. Sebelius Settlement)¶

Rehab facilities often wrongly terminate coverage when a patient with stroke, Parkinson's disease, or dementia stops showing rapid gains in walking distance. Under the federal class-action settlement Jimmo v. Sebelius (Medicare Benefit Policy Manual, Chapter 8), Medicare SNF and Home Health coverage DOES NOT depend on a patient's potential for improvement.

How to appeal a Skilled Nursing Facility cut-off (NOMNC Form CMS-10123)¶

1. Demand the Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123): The SNF must deliver this written form at least 2 calendar days (48 hours) before Medicare coverage ends.
2. Call the BFCC-QIO by 12:00 NOON the day before coverage ends: Unlike hospital appeals (midnight on discharge day), in a Skilled Nursing Facility you must call the BFCC-QIO number on the NOMNC by 12:00 noon on the calendar day BEFORE coverage ends.
3. Demand the Detailed Explanation of Non-Coverage (DENC, Form CMS-10124): Once you appeal, the facility must deliver a written DENC citing the exact clinical and manual reasons for termination.
4. Request Level 2 Reconsideration and Ombudsman help if needed: If the first QIO appeal in a SNF is denied, immediately request an Expedited 72-Hour Level 2 Reconsideration from the Qualified Independent Contractor (QIC) and contact your state's Long-Term Care Ombudsman and SHIP counselors. If a nursing home tries to evict a resident by sending them to an ER and refusing readmission ("hospital dumping"), follow our guide on nursing home abuse, neglect, and illegal eviction.

International discharge protections: United Kingdom, Canada, Australia, and EU¶

Every major public health system has statutory safeguards prohibiting hospitals from discharging dependent seniors without a verified care plan.

United Kingdom (NHS): PALS, Discharge to Assess, and NHS Continuing Healthcare (CHC)¶

Under NHS England's Hospital Discharge and Community Support Guidance and the Care Act 2014, NHS trusts use four Discharge to Assess (D2A) pathways: Pathway 0 (simple discharge with no new needs), Pathway 1 (home with community reablement), Pathway 2 (24-hour bedded intermediate rehabilitation), and Pathway 3 (permanent 24-hour nursing care placement).

If a ward tries to discharge a frail senior on Pathway 0 or Pathway 1 before care workers are scheduled to visit: 1. Contact the Ward Manager (Sister / Charge Nurse) and the hospital's Patient Advice and Liaison Service (PALS) immediately. 2. State in writing: "This is an unsafe discharge. Under the Care Act 2014 and NHS Discharge Guidance, we require a multi-disciplinary assessment for Pathway 2 bedded intermediate care, an NHS Continuing Healthcare (CHC) Checklist prior to discharge, and a Carer's Assessment verifying that family members cannot provide 24-hour lifting care."

Enforcing the CARE Act: Your state law rights as a family caregiver¶

Over 44 US states and territories have enacted the CARE (Caregiver Advise, Record, Enable) Act. Under the CARE Act, hospitals must perform three duties before discharging a patient to a private home: 1. Record the Family Caregiver: Offer the patient the opportunity at admission to designate a family caregiver in the chart. 2. Notify Before Discharge or Transfer: Notify the designated caregiver as soon as a discharge order is written and prior to exit. 3. Provide Live, Hands-On Training for Medical Tasks: Provide a live demonstration and plain-language instruction on all home medical tasks, including sterile wound care, subcutaneous injections (such as insulin or enoxaparin), tube feedings, home oxygen and suction machines, and safe bed-to-wheelchair or Hoyer lift transfers.

How to use the CARE Act to halt a premature discharge: If the nurse hands you syringes, a catheter bag, or wound gauze without hands-on training, refuse to sign. Say: "Under our state's CARE Act, this hospital must provide live instruction and verify that a family caregiver is physically able to perform all medical and lifting tasks before discharge. No one at home can lift the patient safely. Please document that the CARE Act prerequisite has not been met."

Word-for-word advocacy scripts for high-pressure hospital meetings¶

Hospital case managers sometimes claim that "Medicare will stop paying and you will owe 3,000 dollars a day," or "If you do not pick up your parent by 3:00 PM, we will report elder abandonment."

Know the legal truth: refusing to pick up a patient from a licensed 24-hour hospital or nursing facility because you lack the physical strength, medical training, or safe environment to care for them at home is NOT elder abandonment. Inside a hospital, the patient is under the legal duty of care of licensed clinicians. Conversely, taking a bedbound or delirious senior home to an unsafe house where they fall can trigger an Adult Protective Services (APS) neglect investigation.

Script 1: When the discharge planner says "The doctor wrote the discharge order for 2:00 PM today"¶

"My parent is not at their functional or cognitive baseline and cannot safely transfer to the toilet or climb the steps into their house. Nobody at home is physically capable of lifting them. We formally object to this discharge as unsafe. Please hand me the Important Message from Medicare (Form CMS-10065) right now so I can call the BFCC-QIO for an expedited discharge appeal, and page the attending physician and Physical Therapy to re-evaluate transfer safety."

Script 2: Written message to paste into the electronic patient portal (MyChart)¶

"To: Attending Physician, Charge Nurse, and Case Management / Utilization Review. Re: [Nkombo ya mobeli, DOB, Salle]. Svp kotisa note oyo na dossier médical permanent. Libota na biso eyebisi officiellement équipe ya soins que proposition ya sortie na ndaku na [Date] ezali cliniquement insécurité. Yambo ya bokono oyo, [Nkombo ya maladi] atambolaki indépendamment mpe azalaki mentalement clair. Sikawa, [Nkombo ya Mobɛli] esengaka lisalisi ya bato mibale mpo na kotelema, azali na mobulungano makasi, mpe akoki te kokamba bankisi to kokende na twalɛti ye moko mobateli moko te na ndako akoki kotombola [Nkombo ya Mobɛli] to kopesa bokengeli ya ngonga 24, mpe bisaleli ya monganga oyo eumelaka epesameli te Tosengi ya mbala moko botali ya bokengi ya PT/OT, consultation ya Geriatrics, mpe kotindama na mobeli oyo azali na lopitalo Esika ya ba infirmiers ya mayele Tobandi recours ya bolongoli noki na BFCC-QIO (Confirmation #[Number])."

Script 3: Tango Esika ya Infirmier moko ya mayele (SNF) elobi "Moboti na yo a plateau na thérapie physique".¶

"Soki olingi opesa Liyebisi ya kokoma ya Medicare Non-Coverage (NOMNC, Formulaire CMS-10123) mbala moko. Na se ya boyokani ya fédéral Jimmo v. Sebelius mpe Chapitre 8 ya Manuel ya Politique ya Litomba ya Medicare, couverture ya Medicare Part A SNF esengaka te kobongisama ntango nyonso. Traitement ya mayele mpe infirmier efutami ntango nyonso oyo esengeli mpo na kobatela mosala ya lelo to kopekisa kobeba. Moboti na ngai azali naino na mposa." mokolo na mokolo ya monganga ya mayele mpe bolandi ya infirmier mpo na kopekisa kokweya mpe ba contractures, mpe tozali kosala recours ya mbangu na BFCC-QIO yambo ya midi ya lobi."

Nini osengeli kosala AVANT ondima jamais décharge valide¶

Soki mobɛli azali stable na médecine to transfert ya rehab ya sécurité to plan ya soins na ndako esili, silisa oyo Audit ya kobima na sécurité ya points mitano liboso ya kokende:

• 1.1. Boyokani ya nkisi na ligne par ligne ("Audit ya sac marron"): Fanda na infirmier to pharmacien oyo azali na lopitalo mpe tala lisusu nkisi nionso ya ndako pembeni ya ordonnance nionso ya sika ya lopitalo, kondimisa na mokanda: Kokoba na dose moko, Kobongola dose, Tika libela, to Banda nkisi ya sika.
• 2.1.1. "Nkisi na maboko" Yambo ya kokende: Senga pharmacie ambulatoire ya lopitalo ("Programme ya Meds-to-Beds") etondisa mpe epesa ba ordonnances nionso ya sika pembeni ya mbeto yambo ya kokende mpo ete o vérifier ba ndingisa ya liboso ya assurance mpe ba copays na esika wana.
• 3. Bisaleli ya monganga oyo eumelaka (DME) na nzoto na kati ya ndako: Tala soki moto nyonso oyo osɛngi mpo na kotambola, comode pembeni ya mbeto, kiti ya douche, mbeto ya lopitalo, ascenseur ya Hoyer, to concentrateur ya oxygène ezali déjà na kati ya ndako liboso ya kobima. Mpo na bato ya maladi oyo bazwaka oxygène, bozongela lisusu kobongisa kokata kura mpo na ba concentrateurs ya oxygène, ba ventilateurs, mpe CPAP.
• 4. Nkombo ya Agence ya bokolongono na ndako oyo ekomami, nimero ya telefone, mpe mokolo ya botali ya yambo: Zwá nkombo ya sikisiki ya Agence ya bokolongono ya ndako oyo endimi, nimero na bango ya telefone ya ngonga 24, mpe bondimisi ete botali ya infirmier Ebandeli ya Soins (SOC) ebongisami na kati ya ngonga 24 kino 48.
• 5. Ezali na ntina mingi. Nimero ya kobenga lisusu na drapeau rouge mpe rendez-vous ya bolandi ya mikolo 7: Zua nimero ya kobenga lisusu ya clinique ya ngonga 24 mpo na ekipi oyo ezali kobimisa, Bokuse ya bolongoli oyo enyatami, mpe rendez-vous ya bolandi oyo ebongisami na kati ya mikolo 5 kino 7. Soki molingami na yo akweyi na ndako, landa motambwisi na biso mibange kokweya kobika ntango bazali kokoka kotelema te.

Mituna oyo batunaka mingi¶

Lopitalo ekoki kobenga bapolisi to kofunda ngai mpo na kosundola nkulutu soki naboyi kozwa moboti na ngai oyo azali na libateli te mpo na koya na ndako?¶

Te, koboya kozwa bobateli ya nzoto ya mobɛli oyo azali na nzoto kolɔngɔnɔ te to oyo azali kosala mosala te na lopitalo oyo ezali na ndingisa ya kosala ngonga 24 to na esika oyo bayebi mosala malamu mpo ete okoki te kobatela bango na likama te na ndako ezali te ete osundola nkulutu na ndenge ya mabe. Na kati ya lopitalo, mobɛli azali na esika ya monganga oyo ezali na libateli na nse ya mokumba oyo mibeko epesi nzela ya kobatela minganga oyo bazali na ndingisa ya monganga, nzokande komema mobange oyo azali na mokumba na ye na ndako oyo ezali na libateli te kozanga ete atombola lisalisi esalaka ete azoka makasi. Zala na kimia, loba na mokanda ete ozali kotikala na mosala makasi na mwango ya bobateli na bango, mpe limbolá ete ozali kosalela lotomo na yo oyo epesameli na mibeko ya kosala recours mpo na bolongolami na lopitalo oyo ezali na likama te kino ekobongisama ya bozongisi nzoto na ndenge ya malamu to ya bobateli na ndako.

Nini ekosalema soki nazangi mokolo ya suka ya minuit na mokolo ya kobima na lopitalo mpo na kobenga QIO ya Medicare?¶

Soki ozangi mokolo ya suka ya minuit na mokolo oyo esengelaki kobima na lopitalo (to mokolo ya 12:00 ya midi mokolo-yambo ya mokolo ya suka na Esika ya Infirmier ya mayele) kasi mobɛli azali naino na nzoto na kati ya esika, benga BFCC-QIO mbala moko ata ndenge nini. Na nsé ya mibeko ya Medicare ya fédéral, QIO ekondimela kaka recours ya retard ya mobeli oyo azali na lopitalo mpe ekosala botali ya monganga ya lipanda na kati ya mikolo 2 ya manaka, atako obungisi libateli ya responsabilité financière automatique mpo na mikolo oyo botali ya retard ezali kozela longola se soki QIO epesi mibeko na bolamu na yo.

Moboti na ngai azali na makoki ya kosala recours ya bolongoli na Medicare soki bazali na plan privé ya Medicare Advantage na esika ya Original Medicare?¶

Ee, mozwi nyonso oyo akomisami na mwango ya Medicare Advantage (Eteni C) ya privé azali na lotomo ya mibeko ya fédéral ndenge moko mpenza mpo na kozwa Nsango ya Ntina oyo euti na Medicare (na lopitalo) to Liyebisi ya Bobateli ya Medicare te (na esika ya infirmier oyo bayebi mosala malamu) mpe kosala recours ya bolongoli mbala moko, ya lipanda na BFCC-QIO ya etuka (Acentra Health to Livanta). Kosala dossier na BFCC-QIO e déclenchaka séjour automatique ya décharge ndenge moko tango minganga ya QIO indépendants batalaka dossier médical.

Ndenge nini nakoki kosala ete lopitalo abongola moboti na ngai uta na ezalela ya "Observation ambulatoire" kino na ezalela ya "Inpatient" yambo bakende?¶

Senga kosolola mbala moko na Monganga oyo azali kokende kotala mpe Mopesi toli ya monganga ya botali bosaleli ya lopitalo (UR) ntango moboti na yo azali naino na mbeto ya lopitalo. Lakisa ete moboti na yo akatisi to azelami kokatisa midi ya butu mibale oyo esengaka bobateli ya nivo ya lopitalo na nsé ya Mobeko ya CMS ya Midi ya butu mibale, mpe senga botali ya mibeko ya Code 44 ya Ezalela mpo na kobongola ezalela na bango uta na Observation ya Ambulatoire na Mobeli ya Lopitalo ya momesano yambo ya kobima na lopitalo, to tala soki mwango na bango ya Medicare Advantage elongoli mobeko ya mikolo 3 ya mobeli ya lopitalo mpo na bozongisi na mosala ya Skilled Nursing Facility.

Ba sources e vérifié¶

• Ba centres ya ba services ya Medicare na Medicaid (CMS, Etats-Unis): Manuelle ya traitement ya ba réclamations ya Medicare, Chapitre 30: Bobateli ya responsabilité financière, Mayebisi ya recours ya kobima na lopitalo (Formulaire CMS-10065), mpe ba recours ya mbangu na esika ya infirmier ya mayele (Formulaire CMS-10123 ya NOMNC).
• Ba centres ya ba services ya Medicare na Medicaid (CMS, Etats-Unis): Jimmo v. Sebelius Boyokani ya Boyokani ya makambo ya makambo mpe Buku ya politiki ya litomba ya Medicare Mokapo 8 (Mobeko ya bobateli ya bobateli).
• Ba centres ya ba services ya Medicare na Medicaid (CMS, Etats-Unis): Ba recours ya Medicare ya ba reclassifications ya lopitalo kobanda na état ya observation ya ba malades hospitalisés ti na état ya observation ambulatoire (CMS-4204-F / Alexander v. Azar).
• Departema ya bokolongono mpe ya bobateli bato mpe NHS Angleterre (Royaume-Uni): Bolongoli na lopitalo mpe bokambi ya lisungi ya lisanga (Kolongolama mpo na kotala banzela 0 kino 3 mpe Mobeko ya bobateli 2014 Misala ya mibeko).
• Institut ya politique publique ya AARP (Etats-Unis): Mobeko ya CARE (Mobateli apesa toli, akokoma, apesa nzela) Mibeko ya bosaleli ya mibeko.

Ba guides oyo etali yango¶

• Délirium ya lopitalo, mobulungano ya mbalakaka, mpe botomboli ya mikóló
• Kobebisama na ndako ya mibange, kozanga likebi, mpe kobengana bango na ndako na ndenge oyo eyokani te na mibeko
• Mibange bakweyaka kozonga nzoto ntango bazali kokoka kotelema te
• Kokata kura mpo na ba concentrateurs ya oxygène, ba ventilateurs, mpe CPAP
• Mituya ya mbalakaka na mokili mobimba