Question 1

Can the UNC REX case manager promise my mother a bed at a specific rehab facility?

Accepted Answer

No — hospital case managers at UNC REX (or any Triangle hospital) can provide a list of nearby skilled nursing facilities with open beds and help submit referrals, but they cannot guarantee placement at any specific facility, since bed availability and admission decisions belong to the receiving facility. They also cannot promise a particular length of stay or that Medicare will approve ongoing coverage once your mother is there. Ask the case manager for several options in writing and independently check each facility's CMS Five-Star rating on Medicare Care Compare before agreeing to a placement made under time pressure.

Question 2

How do I appeal a discharge I think is happening too soon from a Raleigh-Durham hospital?

Accepted Answer

Every Medicare inpatient at a Triangle hospital — WakeMed, Duke, UNC REX, or UNC Health Johnston — receives a written 'Important Message from Medicare' notice near admission and again before discharge explaining appeal rights; you can request a fast appeal by contacting the Beneficiary and Family-Centered Care Quality Improvement Organization (QIO) listed on that notice before your family member leaves the hospital. Filing the appeal by the deadline on the notice pauses discharge and financial liability while the QIO reviews the case, typically within a day or two. Ask the hospital's patient advocate or case manager for a copy of the notice if you don't have it, since the appeal number and deadline are printed on that specific document.

Question 3

How do I choose a rehab facility quickly when Duke Regional says my husband is being discharged tomorrow?

Accepted Answer

Ask the Duke Regional case manager for a written list of nearby skilled nursing facilities with current bed availability, then cross-check each one's CMS Five-Star Quality Rating on Medicare Care Compare (cms.gov) for staffing levels and recent health inspection results before agreeing. If time allows even a same-day phone call or visit, ask the receiving facility directly about rehab therapy hours per day and physician coverage, since these vary significantly between facilities even within the same star rating. If none of the offered options meet a minimum standard, you can request an appeal to extend the discharge timeline while you evaluate further.

Question 4

My father's Medicare Advantage plan denied coverage after his observation stay at Duke Raleigh Hospital — what are our options?

Accepted Answer

Because his time at Duke Raleigh was classified as observation rather than inpatient, it likely never accrued the inpatient days some Medicare Advantage plans require for skilled nursing coverage, even though your father was physically in the hospital. You can appeal the plan's denial directly with the Medicare Advantage insurer, and separately ask Duke Raleigh's case management or billing office whether the observation classification itself can be reviewed or corrected. If the appeal fails, private-pay short-term rehab or in-home skilled nursing visits (which Medicare Part B can cover regardless of inpatient status) are the fallback options.

Provider	Based in	Address	County
Brookdale Smithfield	Smithfield	830 Berkshire Road, 27577	Johnston
The Landings of Smithfield	Smithfield	200 Kellie Dr, 27577	Johnston
Sunrise of Raleigh	Raleigh	4801 Edwards Mill Road, 27612	Wake
Sunrise at North Hills	Raleigh	615 Spring Forest Road, 27609	Wake
Spring Arbor of Raleigh	Raleigh	1810 New Hope Rd, 27610	Wake
Springmoor	Raleigh	1500 Sawmill Road, 27615	Wake

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