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ADMISSION PROCESS

Patients who are least 14 years old can be admitted to a Magee program in spinal cord injury, brain injury, stroke or orthopedic injuries directly from an acute care hospital, sub-acute facility, nursing home, or from the patient's home.

Magee admits patients seven days a week. The process begins with a referral to the Magee Admissions Department. A referral may come from a patient's attending physician; primary care physician; insurance company representative; or hospital discharge planner (e.g. social worker, nurse or case manager).

The process begins with a referral to Magee's Admissions Department by calling 215-587-3117. A referral may come from a patient's attending physician, primary care physical, insurance company representative, or hospital discharge planner (e.g. social worker, nurse, or case manager).

During this evaluation, the Magee Rehabilitation Hospital liaison can help patients, families and acute care treating professionals to discover if rehabilitation is appropriate at that time, and the options available. Liaisons can also help untangle insurance concerns.

When the admission has been approved by Magee and the patient's insurance company, the acute care hospital will make transportation arrangements for the patient to be moved to Magee. We recommend that a family member or other support person attend on the day of admission, to learn about the initial plan of care and to share information that will facilitate a good transition for the patient.

Talking With Your Insurance Company

Every insurance plan has a specific set of guidelines that the company uses for approving an inpatient rehabilitation hospitalization. If you learn that your loved one has not been approved for an inpatient stay, there is a method for asking the insurance company to take a second look at that decision. That method is called "Appealing the denial", and can be initiated by the prospective patient or their representative.

For an insurance that is not Medicare: To appeal a denial, call your customer service department for the insurance company, and state that you would like to appeal a denial of decision. You will be connected with the appeals division of the company, and you will be informed of the additional information the company need to reconsider the decision. Usually, the insurance company requests additional documentation about services that have already been provided, for example, additional notes from the acute care record. Some companies ask for a proposed plan of rehabilitation care from Magee Rehabilitation Hospital. If this is requested, contact the admissions department at Magee (215-587-3117) to make this request. There may be several levels of appeal possible, so if there is a second denial, ask to be direct to the next level of appeal.

For Medicare: If the prospective patient is a Medicare beneficiary, and Magee finds that that patient does not meet Medicare funding guidelines, the prospective patient or their representative can also appeal that decision. The decision is reviewed by a third party called "Quality Insights of Pennsylvania." You may initiate the appeal by informing the evaluating clinical liaison that you wish to do so, or by calling the Magee Utilization Review Department (215-587-3332). Specific directions for appealing the decision will be given to you at that time.

WHAT TO LOOK FOR IN A REHABILITATION HOSPITAL

How to choose services for you and your loved ones

A Guide from CARF

Finding the right service provider can be difficult; you want a provider that will help you and your family members with a genuine, person-centered attitude. You and your family have the ultimate power to choose your services. This guide provides some pointers on how to help gauge which provider will work best for you.

When shopping for services, there are some things that may help you move through the process

  • Know what to ask before you go. How many times have you left a place and said "Oh, I should have asked about that!" If you take time to prepare questions, you can direct the session to get them answered.
  • Take notes. This will allow you to refer back and compare between service providers.
  • Take a trusted friend or family member with you. Having a second set of ears can provide perspective later when you're making a decision.

Should I schedule an appointment

Sometimes a simple call with questions will give you a good sense if a provider will meet your needs. In a preliminary chat you may ask:

  • What services do you offer
  • Will here be bilingual staff or sign language interpreters if I need them?
  • Will my services be covered by insurance, government funding (such as Medicare or Medicaid), or other resources>

How do I feel when I walk in?

First impressions are often right. And although your final decision will be based on several factors, you can assess some important attitudes of the services provider before getting past the lobby.

When you walk in, there are many things you may notice:

  • Was I greeted in a friendly manner?
  • Did they see me in a reasonable amount of time?
  • Do the premises appear to be well maintained, clean, and safe?

What are your Services

Now is the time to get down to the nitty-gritty. Besides asking about what services are provided, you may want to ask the organization these additional questions:

  • How long does it take to begin service?
  • Is there a waiting list?
  • How often will I receive services, and how long will they last?
  • How will I or my family participate in planning services?
  • Are your staff members qualified for the work they do?
  • What are my rights?
  • What would my responsibilities be?
  • What happens to individuals like me here?
  • What can I expect as a result of services?
  • What will this cost me?
  • If I need transportation, how can you help?
  • If I need other assistance, is it available?
  • Who can I contact if I have more questions?

Now What?

Now you get to make decisions about what services you would like. This is a personal choice that involves you and your family members. As you look back on your notes and consider the opinions of friends or family members who accompanied you, there are some final questions that are relevant as you decide to participate in service:

  • Overall, was the provider courteous, helpful, and respectful?
  • Did they answer my questions
  • If they couldn't answer my questions, did they refer me to somebody who could, or offer to follow up with answers
  • If they didn't provide al the services I need, did they refer me to an organization that could provide what they don't?
  • Are the hours and location convenient for me?
  • Would I be comfortable receiving services here?
  • Did staff members seem interested in me and the services I need?
  • Did the provider follow up when it should it would?

Where can I find an assurance of quality

Look for CARF accreditation. It shows the provider is committed to meeting international standards of quality.

What is CARF?

CARF is an independent, nonprofit organization that accredits several types of specialized services, including aging services, behavior health, child and youth services, DMEPOS, employment and community services, and medical rehabilitation for persons of all ages.

If you are looking for a provider for one of these types of services, please contact:
CARF International
CARF Canada
CARF-CCAC

The mission of CARF is to promote the quality, value, and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of the persons served.

Copyright CARF 2008 All Rights Reserved.