Case Study: Finance And Reimbursement

Case Study: Finance And Reimbursement

In this interactive case study, you will learn about Hilda Smith, a woman who requires extended care and rehabilitation services due to a fall in her home. Completing this activity will help you apply what you've learned about financial management in a healthcare situation. 

Instructions

1. Review Case Study #2: Finance and Reimbursement (below)
2. Use the template (attached) & the information from the case to answer the questions.

Case Study

Introduction

This case study follows Hilda Smith, a patient at an acute care hospital. As you watch her story unfold, think about how a case manager might incorporate a collaborative process that encompasses various areas of medical care to deliver a personal and tailored recovery plan.

Meet Hilda Smith

Hilda Smith, who had osteoporosis, sustained a hip fracture because of a fall in her home.

After 5 nights in an acute care hospital, she is admitted to an SNF where she spends 16 days for rehabilitation, nursing care, and assistance with activities of daily living. The resident is then discharged to her own home where a physical therapist from a home health agency comes in to train her to use a walker and build strength.

After being at home for 25 days, Hilda develops deep venous thrombosis (blood clot in a vein) in her thigh (related to her fall) and is admitted to the hospital, from where she is transferred to the same SNF after spending 2 nights in the hospital.

Conclusion

Write your answers in well-developed sentences or short paragraphs, using your own words.

As the case manager, how would you respond to the following questions?

1. Assuming that Hilda meets Medicare criteria for the services described here, how many days of SNF care is she entitled to during her most recent stay (assume that she qualifies for the full 100 days)?
2. How much in deductibles and copayments does Hilda have to pay? (For 2021, the Part A deductible was $1,484 and the daily copayment for SNF was $185.50.)