First, some prostheses are excluded from consolidated billing. You need to know the code of the prosthesis ordered and then check on the consolidated billing transmittal to see if it is an exclusion. The AANAC site has links to the consolidated billing transmittals.
If it is not on the list of exclusions, unfortunately, it is where the resident is located when the prosthesis is delivered. So the SNF would most likely be billed not the acute care hospital. If the resident is off of skilled services before the prosthesis arrives, it would not come out of your PPS rate. But if still on skilled services the facility would be responsible for the bill , unless the prosthesis is one of the exclusions. Hope the hospital ordered an excluded type. Exclusions are usually the Pinto models, not the Cadillacs of prostheses.
-----Original Message-----
From: [EMAIL PROTECTED]
Sent: Oct 29, 2003 7:50 AM
To: [EMAIL PROTECTED]
Subject: Payment for prosthesis
Help! I'm having a brain cramp. Our facility is considering accepting a patient who is an old amputee who requires a new prosthesis. In the acute hospital rehab has him hopping, and it appears he is ready to be fitted. Here's the question:
If he is measured and the prosthesis is ordered in the hospital, who is responsible for the cost, and does responsibility for cost depend on location when it is ordered or when it is delivered? This gentleman will be very high cost to begin with and my Administrator is wondering who bears the cost of the prosthesis, as this gentleman is also a hemodialysis patient.
Thanks!
/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
-----Original Message-----
From: [EMAIL PROTECTED]
Sent: Oct 29, 2003 7:50 AM
To: [EMAIL PROTECTED]
Subject: Payment for prosthesis
If he is measured and the prosthesis is ordered in the hospital, who is responsible for the cost, and does responsibility for cost depend on location when it is ordered or when it is delivered? This gentleman will be very high cost to begin with and my Administrator is wondering who bears the cost of the prosthesis, as this gentleman is also a hemodialysis patient.
Thanks!
