Strategizing Skilled Care: Conducting Effective Medicare Meetings for Resident Care Coordination

Medicare meetings focused on current residents receiving skilled care are crucial for managing and coordinating the care, rehabilitation, and discharge planning of Medicare beneficiaries. These meetings often involve a multidisciplinary team, including but not limited to MDS coordinators, nursing staff, rehabilitation therapists, social workers, and billing specialists. The primary goal is to review each resident's progress, plan for discharge, manage transitions in care, and ensure optimal use of Medicare benefits. Here's a structured approach to conducting these meetings effectively:

Objectives       

1. Review of Resident Progress: Evaluate each resident's recovery progress against established care and rehabilitation goals.
2. Discharge Planning: Discuss anticipated discharge dates and post-discharge care requirements, including any necessary home modifications or support services.
3. Goal Setting Post-Skilled Care: Establish or update goals for residents after discharge from skilled nursing care, focusing on maintaining or improving their quality of life.
4. Payor Source Evaluation: Review any changes in payor sources and implications for care and billing.
5. Medicare Coverage Tracking: Monitor the number of days each resident has remaining under Medicare coverage and discuss any impending coverage limits.
6. Co-Payment Requirements: Identify any co-payment obligations for residents and communicate these financial responsibilities clearly to residents and their families.
7. Rehabilitation Services Review: Assess the level of services provided by the rehabilitation department, including physical, occupational, and speech therapy, and make adjustments as needed.
8. MDS Coordination: Schedule and plan for required MDS assessments to ensure accurate and timely completion.

Key Discussion Points

• Resident's Rehabilitation Progress: Detailed discussion on each resident’s improvements, challenges, and any adjustments needed in their rehabilitation plan.
• Discharge Timing and Readiness: Criteria for discharge, including achievement of rehabilitation goals and readiness for transition to home or another care setting.
• Post-Discharge Support Plans: Identification of support systems, community resources, or outpatient services required post-discharge to support the resident's continued recovery and well-being.
• Financial Planning for Care: Overview of Medicare coverage, private insurance, or out-of-pocket costs associated with ongoing care needs.
• Coordination of Care: Strategies for ensuring a smooth transition from skilled nursing care to the next care setting, including communication with future care providers and arrangements for necessary equipment or home health services.

Best Practices for Conducting Medicare Meetings

• Preparation: Ensure all relevant data on each resident's progress, therapy notes, MDS schedules, and billing information are prepared and available for discussion.
• Interdisciplinary Involvement: Engage all relevant disciplines in the meeting to provide a holistic view of each resident's care and needs.
• Clear Communication: Maintain clear and open communication with residents and their families regarding care plans, Medicare coverage, and any anticipated changes.
• Documentation and Follow-Up: Document key decisions, action items, and assigned responsibilities during the meeting. Schedule follow-up meetings or reviews as needed to reassess residents' progress and adjust plans accordingly.
• Regulatory Compliance: Always ensure that discussions and decisions comply with Medicare regulations and guidelines, as well as with any other relevant federal or state laws.

By focusing on these areas during Medicare meetings, healthcare facilities can enhance the quality of care provided to residents, ensure efficient use of Medicare benefits, and support residents' transition either back to the community or to another care setting in a coordinated and patient-centered manner.