Commercial and Managed Medicare Coverage

Commercial and Managed Medicare Coverage

Stefanie Villasante
Business Office Coordinator
The GRAND of Dublin

What does your Commercial or Managed Medicare insurance mean for your rehabilitation stay? It important that you understand how your coverage effects a variety of areas of your stay in a short term rehab facility, from admission, to type of room, to amount of therapy you receive to per day/week, how much it will cost you out of pocket, up to your prospective discharge date.  If you are looking for Skilled Rehab for yourself or a loved one it is important that you educate yourself on what coverage you have.  A lot of times the Business Office at your prospective Facility has access to this information and can help you understand your coverage.

Most Insurance providers require precertification for you to even come to a Skilled Nursing Facility.  This is done by the facility, with the paperwork provided to them from the hospital.  Some insurance companies will only authorize a Semi-Private room (you’re bunking up with a stranger for your rehabilitation stay).  A request is submitted to the insurance company and they generally take 24-48 hours to respond (they don’t always say yes).  You cannot transfer to the facility until the service is authorized.  Once the hospital and facility are notified of authorization, the hospital will then arrange transportation to the rehab center.

Medicaid CoverageMany Insurance companies cover 100% for the first twenty days, following a more Medicare-like guideline. The will have a set amount or percentage due per days for days twenty one on.  Other insurance plans have a deductible due up front and a daily coinsurance starting on day one of admission.  Almost all Insurances have an amount that you have to reach paying privately before they pay your services at 100% with no Out of Pocket cost.  This is known as your annual Out of Pocket Max.

Some Insurance companies have a “Level” that they assess your rehab need at.  This level dictates the amount of nursing care and therapy the facility will provide to you on a daily/weekly basis.  (Example: Anthem Level 2 covers 90 minutes of Therapy no less than 3 days per week, where Anthem Level 3 states 90 minutes of Therapy no less than 5 days per week).  So you might come into your Rehab stay thinking that you will have therapy 5-7 days per week, and might only be seen 3 times a week because that is all your insurance has authorized the facility to treat.

On a regular basis your Insurance Company will ask for updates from the facility.  These updates include nursing and therapy notes documenting your progress (or sometimes lack of progress).  At any point that insurance company can decide that you are ready to go home, or no longer meet skilled criteria and are in need of Long Term Care which is not covered by the insurance.  Managed Medicare Insurance plans will issue a “Notice of Medicare Non-Coverage” giving you AT LEAST a two day notice.  They are not required to give you any more notice than 2 days that you will no longer be covered your skilled stay.  If you have a commercial insurance plan, they do not have to follow Medicare guidelines and do not need to give you any notice.  A commercial plan might review your update, and say we are going to stop paying effect the previous day.  It is on you to discharge or pay privately at the facility if you stay.

With all of the different types of Insurances and Plans out there it is important to do your research before selecting one for yourself.  If you do find yourself in a situation where you don’t know your coverage or have questions, call your insurance company, talk to your hospital social worker, or the Business Office at the Rehab facility.  We all have a plan in mind of how everything will work out perfectly.  Unfortunately your insurance company (and life) doesn’t always follow that perfect plan.  Make sure you are doing your homework, so things don’t come up and leave you so shaken that is sets you back in your progression to home.

 

RESIDENT RIGHTS Continuation

Catherine Denlinger, MSW, LSW
Director of Social Services
The GRAND of Dublin

RESIDENT RIGHTS

This SSS (Social Services Series) will be the continuation and completion of Ohio & Federal Nursing Home Residents’ Bill of Rights. During our last series we looked at the first five resident rights. We will resume summarizing the resident rights continuing with number twenty-five.

25. Residents have the right to be informed in writing of the basic rate charged by the center, services available and any additional charges related to such services. The basic rate of the center shall not be changed unless a 30 day notice is provided to the resident and/or the resident’s responsible party.

26. Residents have the right to receive their bill on a monthly basis for any charges not included in the basic rate.

27. Residents have the right to be free from financial exploitation. Residents have the right to manage their own financial affairs and/or the right to quarterly accounting statements if the center is delegated this responsibility. Residents have the right to review a complete record of their funds, transactions, bills, etc.

28. Residents have the right to access their valuables/property that are on deposit at the center at reasonable hours.

29. Residents have the right to receive notice prior to a room change and/or having a roommate as well as an explanation to the fact. The Grand has all private rooms.

30. Residents have the right not to be discharged or transferred from the center unless for the following reasons: for the safety of other residents in the center, the health of residents in center would be endangered, the resident’s health has improved and he/she no longer meets the criteria for services provided in the center, and/or the welfare/needs of the resident cannot be met in the home. Other reasons may be that the resident has failed to pay for the services provided in the home, the center’s license has been revoked and/or the home is being closed, the resident receives Medicaid and the center is terminating the Medicaid program w/in the center, the resident receives Medicare and the center is terminating the Medicare program w/in the center.

31. Residents have the right to voice grievances and recommend changes to the center’s employees, to The Department of Health, or to any other person not associated with the center (Ombudsman, Legal Rights, family, friends, etc.). Residents are able to do this per their choice, free from restraint, interference, coercion, discrimination or reprisal.

32. Residents have the right to be informed of any significant change in their health status as well as their responsible party/emergency contact. The center shall make every reasonable effort to notify the resident and/or their responsible party/emergency contact as soon as the significant change is noted.

Hiring Therapy Tech/Scheduler

Hiring Therapy Tech/Scheduler

Monday – Friday 9:00am – 5:30pm

We are currently looking for an experienced Therapy Tech/Scheduler to join our team at The Grand, located at 4500 John Shields Parkway, Dublin, OH 43017.

The Grand has 143 beds consisting of Skilled Nursing, Assisted Living and Independent Living.  You will be working at a one of a kind, state of the art facility in Central Ohio.

Our Mission:

Our every action must advance our mission: To improve the Quality of Life & Health of those we serve.

Company Overview

Vrable Healthcare is a growing Ohio company privately and locally owned with the vision of providing exceptional care across Ohio. We believe our first responsibility is to the patients we serve. We respect the physical, emotional and spiritual needs of our patients and find that compassion is essential to fostering healing and wholeness. Teaching and learning are fundamental in our efforts. We believe our employees are the source of our success.

 Qualifications 

  • Degree in exercise physiology
  • Experience with scheduling
  • Excellent organizational skills
  • Solid computer knowledge – excel, word, power point
  • Background in skilled rehab
  • Excellent communication skills

Vrable Healthcare is a trusted name providing skilled nursing and rehabilitation services throughout Ohio.  We offer competitive wages and benefits including 401k, tuition assistance, and paid vacations.

Interested in joining our team?  Qualified candidates should apply online at www.applyatvhc.com and visit us online at www.vrablehealthcareinc.appone.com

Main Street: Created for Life and Designed for Living

Sara Katula
Activities Director
The GRAND of Dublin

Main Street: Created for Life and Designed for Living

Main Street at The GRAND offers many attractions that we are able to incorporate with our daily activities including our This and That Sundries gift shop, Main Street Chapel, seasonal courtyards, Digger and Finch Pub, What’s The Scoop? Ice cream parlor, activity center, and The GRAND Theater.  When you first enter Main Street you will see our Cool Beans Café.  It is open daily offering everything from a cup of coffee, deli sandwiches, daily soup specials, snacks, variety of drinks and a community newspaper is available to catch up on the daily news. Across from the Café is our This and That Sundries gift shop.  Our gift shop offers anything from daily necessities, seasonal décor, Ohio State gear to flower arrangements or trinkets.  Open daily for our residents and guest to shop at their convenience.

The next two attractions along Main Street are our chapel and the GRAND Theater.  The Main Street Chapel is designed for multi-denominational services to be held throughout the week with support from our local churches.  We have various church events throughout the week including memorial services, private ceremonies, or wedding renewals. Hospice companies may also use our chapel for coping, support and counseling.  The GRAND Theater plays daily movies posted outside the theater from 10am to 11pm. Our movie selection changes monthly playing both current and classic movies. Sporting events are shown in our theater especially the World Series, Super Bowl, and Ohio State Football.

Main StreetA few of our residents favorite attraction includes our What’s The Scoop? Ice cream parlor and Digger and Finch Pub. Our ice cream parlor is open Wednesdays and Saturdays at 3:00pm to satisfy any sweet tooth.  Many residents enjoy their ice cream in our seasonal courtyard that is decorated for harvest days, Thanksgiving, Christmas, and Easter. Families or guests may also use our ice cream parlor for hosting birthday parties, social events, and special occasions. The Digger and Finch Pub are open on Thursday evenings for Bingo night and Fridays at 3:00pm for Happy Hour. During Happy hour you can enjoy entertainment and appetizers along with your drink of choice.

At the end of Main Street there is our activity center that is designed for many of our traditional activities provided by our activity staff. We offer a variety of activities that will accommodate all of our guests to keep them busy and social.  Our activity staff passes out a daily activity schedule along with a monthly calendar posted in all the rooms to invite all residents, family, and guests. Main Street offers many activities and events for our residents and families to enjoy during their stay at The GRAND of Dublin Senior living community.

Swallowing is a basic function that we all take for granted

Jeanne R. Seliskar, MA, CCC-SLP
Corporate Director of Rehabilitation
Vrable Healthcare Companies

Swallowing is a basic function that we all take for granted

Swallowing VitalStim PlusOnce it becomes difficult to swallow or a person is at risk for aspiration, then the speech pathologist becomes an important expert in remediation of this process.  At The GRAND of Dublin, our speech pathologists have the expertise and the latest technology at hand to treat even the most difficult cases.  VitalStim Plus is an electrotherapy and sEMG Biofeedback System designed for interactive therapy dynamics allowing patients to receive visual and audible feedback leading to enhanced patient engagement during swallowing exercises.  Supplementing a standard therapy program with sEMG biofeedback facilitates functional swallowing recovery.

This device allows the speech pathologist to guide patients through personalized targeted swallowing exercises.  Programs allow the clinician to truly customize treatments while biofeedback and visuals create a patient-focused experience that encourages participation and achievement of goals.

VitalStim Plus neuromuscular electrical stimulation helps recruit and re-educate the muscles critical in the process of swallowing.  The muscle strengthening, targeted in this process, rehabilitates swallowing, leading to increased effort and duration of the swallowing attempts as well as improved coordination.  Improvements in swallowing lead to upgrades in diet resulting in improved nutrition and quality of life for our patients.

About The GRAND of Dublin

THE GRAND offers luxury accommodations in a premier resort style community. Our Clinical Professionals provide first-class healthcare inspired to elevate the quality of life in a country-club style environment. THE GRAND defines the art of luxury living, coupled with the security of Post Acute Care and Rehabilitation Services with the ambience of a resort hotel.

Your skilled nursing and post-hospital medical and rehabilitation services are an important part of your recovery. Our interdisciplinary team of trained medical professionals treat each person holistically in order to provide the greatest opportunity for you to achieve your discharge goals. Working together, the team creates a customized plan of care to deliver the necessary support for a successful discharge back home. Your quality of life is important to us. It is our goal to ensure everyone feels at home and is being provided the highest quality of care and services.

The Difference Between Rx and OTC Meds

Andrea Hartley, CPhT
Pharmacy Technician/Central Supply Manager
The GRAND of Dublin

The Difference Between Rx and OTC Meds:
Why some medications are prescription, some are OTC (and some are a little of both).

Have you ever wondered why some medications are prescription only, some are sold over-the-counter, and some are a little of both?  During your stay at The Grand, you don’t need to worry about it: we provide you with all standard medications you are taking, whether prescription or OTC.  While at home however, you may be confused about what you can purchase, and what you need a prescription for, and why.

medicationsLet’s start with the reasons a drug has been designated as Prescription Only.  These medications are also known as Legend drugs, because of the required presence of the Federal Legend: “Caution: Federal Law

Prohibits Dispensing Without a Prescription”, on the label.  In 1997, this was shortened to simply, “Rx Only”.  The foremost reason for an Rx Only designation is safety.  If a product is known to have the potential for harmful effects or is unsafe without the supervision of a physician, it may not be sold without a prescription.  These medications may require diagnosis of a specific illness by a healthcare professional as well.  A drug may also be Rx only because it has the potential for abuse.

Now, on to medications designated as OTC.  An OTC product almost always begins its life as Rx Only.  In order to make the switch, manufacturers must provide proof to the FDA that a medication is very safe and effective and whether the labeling can be written in such a way that consumers can use the products safely without the intervention of a healthcare provider.  Of course the company which developed the drug for prescription use must also be willing to provide this proof, or “sponsor” the transition.

Finally, what about the medications which are sold behind-the-counter (BTC); and the medications that are sold as both Rx only and OTC?  This is where things get a bit more complicated.

Let’s talk about BTC items first.  These items are actually considered over-the-counter because a prescription is not needed, but they can only be purchased from a pharmacy.  Items vary based on location, but chances are you have purchased one of these items before:  pseudoephedrine, codeine-containing cough syrups, syringes and needles, emergency contraceptives, and some insulin.  BTC is not an official classification of drugs in the US, yet it still exists for various reasons.  Pseudoephedrine and codeine cough syrups have quantity restrictions and pharmacies must track who purchases them, and how much; this is required to reduce abuse and diversion.  Emergency contraceptives require age verification; human insulin is OTC because it was thought to be less dangerous than modern formulations but sold behind the counter due to its refrigerated storage requirements.  As for the syringes and needles, some states require proof of need, age and/or records of purchase.

Drugs sold as both prescription and OTC are usually done so due to small differences in either the medication or the way it is packaged.  For example, the FDA has approved the OTC sale of Prilosec only as treatment for frequent heartburn, whereas the Rx Only version is approved for more serious conditions such as such as inflammation of the esophagus and ulcers.  On the other hand, the reasons the FDA approved Miralax for OTC sales, yet still allows the sale of Rx Only PEG 3350 are unclear.  Both medications are identical with nearly identical indications for use.

When you stay with us at The Grand, the nursing staff and I are here to answer your medication questions; if you want to know something, just ask!

Hiring – Nurse Aide Training Instructor (RN)

Hiring – Nurse Aide Training Instructor (RN)

Great Hours, Pay and Benefits!!

We are currently looking for a Nurse Aide Training Instructor to join our team in Columbus, Ohio.

The Grand has 143 beds consisting of Skilled Nursing, Assisted Living and Independent Living and you will be working at a one of a kind, state of the art facility in Central Ohio.

Our Mission:

Our every action must advance our mission: To improve the Quality of Life & Health of those we serve.

Company Overview

Vrable Healthcare is a growing Ohio company privately and locally owned with the vision of providing exceptional care across Ohio. We believe our first responsibility is to the patients we serve. We respect the physical, emotional and spiritual needs of our patients and find that compassion is essential to fostering healing and wholeness. Teaching and learning are fundamental in our efforts. We believe our employees are the source of our success.

Qualifications

  • Must be an RN
  • “Train the Trainer” certified STRONGLY preferred
  • 3 years of LTC experience required.
  • Knowledge of local, state and federal regulations pertaining to facility functions.
  • Excellent communication and interpersonal skills.

Vrable Healthcare is a trusted name providing skilled nursing and rehabilitation services throughout Ohio.  We offer competitive wages and benefits including 401k, tuition assistance, and paid vacations.

Visit us online at www.vrablehealthcare.com

Interested in joining our team?  Qualified candidates should send a resume along with salary requirements to www.vrablehealthcareinc.appone.com

EOE

September 2018 Activity Calendars

Skilled Nursing Activity Calendar

Activity Calendar
GRAND of Dublin September 2018 Skilled Nursing Activity Calendar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Assisted Living Activity Calendar

Activity Calendar
GRAND of Dublin September 2018 Assisted Living Activity Calendar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Memory Care Activity Calendar

Activity Calendar
GRAND of Dublin September 2018 Memory Care Activity Calendar

Resident Rights

Catherine Denlinger, MSW, LSW
Director of Social Services
The GRAND of Dublin

Resident Rights

This SSS (Social Services Series) will be a continuation of Ohio & Federal Nursing Home Residents’ Bill of Rights. During our last series we looked at resident rights six to fifteen.  We will resume summarizing the resident rights continuing with number sixteen.

  1. Residents have the right to pursue opportunities at their own expense to achieve their fullest potential including but not limited to social, recreational, vocational, habilitation and/or educational programs.
  2. Residents have the right to consume a reasonable amount of alcohol at their own expense unless not medically advisable in writing by physician. The Grand has a pub that serves alcoholic and nonalcoholic beverages during our happy hour.
  3. Residents have the right to use tobacco at their own expense unless not medically advisable in writing by physician. The Grand is a nonsmoking center.
  4. Residents have the right to wake up and go to bed per their preference as long as they do not disturb others or the posted meal schedules and/or unless not medically advisable in writing by physician.
  5. Residents have the right to attend/observe/participate in religious activities, the right to maintain individual and cultural identity and the right to participate in activities of their choosing.
  6. Residents have the right to private communication with family, social worker and/or any other persons unless not medically advisable in writing by physician. Resident further have the right to receive, send and mail sealed, unopened correspondence, access to a telephone for private communications, and/or private visits at any reasonable hour.  The Grand has all private rooms and private phones with individual phone numbers.
  7. Residents have the right to privacy of his/her spouse and/or if both reside at the same center, to share a room unless not medically advisable in writing by physician.
  8. Residents have the right to have privacy by having their doors closed and to be knocked upon prior to opening, unless not medically advisable in writing by physician and/or in the case of an emergency.
  9. Residents have the right to have their personal clothing and to have their own possessions at the center unless not medically advisable in writing by physician.

Open House – Immediate Interviews

Open House – Immediate Interviews

August 16, August 23 and August 30
9am to 3pm
THE GRAND of Dublin 

Now Hiring LPNs and STNAs

$500 Sign On Bonus for full time STNAs

Stop in for an immediate interview and be entered into a drawing for a $25 gas card

Refreshments will be provided
EOE