How much does Medicare pay for a room - just the room, overnight?

May 13, 2013 1:11 PM

[USA filter] Even with the new disclosures I can't figure out how much Medicare pays for just a hospital or nursing home room - 24 hours. Just the room charge.

I'm helping a person with no insurance negotiate a hospital bill and a short stay in a nursing home bill. How much does Medicare pay for a room - 24 hours - in a nursing home and in a hospital? I understand that rates vary by location. I'm just looking for examples. And my patient was in a rural hospital in a town of about 30,000 in Idaho. If you know how to look up a comparable hospital.

posted by cda to Work & Money (6 answers total)

Medicare Part A billing doesn't work like that, to my understanding. They're paid based on diagnosis-related group under the prospective payment system, not based on the actual nights you stay in the hospital or whatever.
posted by Sequence at 1:28 PM on May 13, 2013 [1 favorite]

My understanding is the same as Sequence's. The big data release was all just DRGs. The exception where you'ed see something relating to the cost of the room would be for a medically unnecessary "upgrade" from a semi-private to a private room. Even there, it's not as simple as just room and board, since some services might be more expensive to provide in a private room, some might be less.
posted by pjaust at 1:31 PM on May 13, 2013

Response by poster: OK, I hear what you are saying about DRGs for the hospital stay.

For the nursing home stay he was charged a room rate - I think it was about $250. What does medicare pay for a 24 hour stay in a nursing home?
posted by cda at 1:36 PM on May 13, 2013

When Medicare covers nursing homes at all, it's the exact same deal (I think, as before). Otherwise, it's Medicaid, for long-term, but that wouldn't be comparable.
posted by Sequence at 1:40 PM on May 13, 2013

Idaho CareLine should be able to help.
posted by rada at 1:50 PM on May 13, 2013

Response by poster: Now I remember that the hospital quoted him a room rate of about $800 a night - just for recuperating - that's why he got admitted to a nursing home for the recuperation period because it was going to be a much lower priced room rate. So I'm confused that Medicare doesn't have room rate amount they pay.

I will call Idaho Careline, thanks rada.
posted by cda at 6:11 PM on May 13, 2013