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Make sure your Medicare denial letter states the
daily charge for him to continue to stay at your facility at a lower
level of care, and that billing at this rate will begin on the day of the
denial of Medicare payment. This will give him the option of paying a
daily room rate, plus meds, etc. Might not take him too long to decide this
is far more expensive than another place to live.
Good luck,
Julia A. Onken, R.N. LTC Nurse
Manager
Goshen Care Center
2009 Laramie Street
Torrington, WY
82240
Phone (307) 532-4038 ex.
3044
Fax (307) 532-3800
![]() ![]()
Thank
you very much for that referral, you took the words out of my
mouth.!!
![]()
Ombudsman Of The Year 2001
Chairwoman
2003-2004
The North Miami Dade, Florida: Long Term Care Ombudsman
Council
I would also notify your
Ombudsman that you are issuing the denial letter
that day
also.
Tammy Gola BSN, RN, CRNAC
Wilkes-Barre General
Hospital
Transitional Care Unit
575 North River Street
Wilkes-Barre,
PA. 187641-0001
570-552-5417
[EMAIL PROTECTED]
-----Original
Message-----
From: Gola, Tammy [mailto:[EMAIL PROTECTED]
Sent: Tuesday,
November 25, 2003 11:53 AM
To: '[EMAIL PROTECTED]'
Subject: RE: notice of
non coverage
What about calling department of public welfare for
guidance?
Would they not consider a personal care home?What is the
guardian/POA' s
take on all of this?
Tammy Gola BSN, RN,
CRNAC
Wilkes-Barre General Hospital
Transitional Care Unit
575 North
River Street
Wilkes-Barre, PA.
187641-0001
570-552-5417
[EMAIL PROTECTED]
-----Original
Message-----
From: karen white [mailto:[EMAIL PROTECTED]
Sent:
Tuesday, November 25, 2003 10:57 AM
To: [EMAIL PROTECTED]
Subject: notice
of non coverage
Importance: High
I have a question for the
group. I am on a SCU in a hospital, we have a
resident, 49 years old who
has been here for 29 days today. Here for rehab.
History is chronic back
pain from mva in past, pain drug addiction, severe
neuropathy, dm, severely
obese >450 lbs. Prior level of function was
bedbound (really sofa bound)
being cared for by wife who also was in the
mva, and pain drug addiction.
She was in drug rehab and now out.
He has been participating in rehab, is
now independent, to supervision with
adl's. Ambulates with walker > 200
feet. Uses toilet, but unable to cleans
self due to old shoulder injury.He
has lost weight since here and in our
minds much better than prior level of
function.
Both resident and spouse are now homeless due to being evicted.
Resident
has POA and guardian due to his past impaired ability (drug
addiction).He
continue to need pain meds but much less than prior to
hospitization.
Together resident and wife get disability but medication
expenses are high.
They are saying they have no where to go, yet are not
looking, They know how
to work the system if you know what I mean. Talking
of separating so he can
get Medicaid, etc. We have told him, wife, POA and
guardian that we are
planning on discharge on DEC. 3. We picked this date
as both him and his
wife get their checks on DEC. 1. (they had stated they
had no money to go
anywhere.) Now they are still complaining that she
cannot take care of
him.Wife is staying at her mothers. He is not welcome
there. We have given
lists of low income housing, homeless shelters,
agencies to assist them. But
they are making no efforts. They say they make
to much money for low income
housing, but due to their m
edication
expense they can't afford regular housing.
I have never had to issue a
denial letter before and want to make sure we
do it right. Can anyone coach
me through this? Are we right in our
determination that he no longer needs
our services? And that Medicare should
pay for him to live here. If he
refuses to leave what do we do, do I
continue to do MDS's and submit and
get refused payment? What complicates
this situation is we are a non-profit
religious hospital and meet lots of
resistance. That is how we ended up
with him in the first place, he was in
acute care, finished his DRG and no
other facility would take him due to his
size. They could not provide care.
So rather than loose money upstairs, he
came here.
Sorry its so lengthy.
KAREN
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