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


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


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


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


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