"Routine" care during Med A stay

[Holly Sox, RN, RAC-C]

Hi, Group,   Tell me how y'all handle "routine" stuff that comes up during a Med A stay.  (Such as eye care, other follow up visits that are unrelated to the qualifying hosp stay.)   Right now, we have 2 medicare residents who had been scheduled for cataract surgery prior to their acute illnesses which precipitated their hosp stay and SNF admission. One of them had bowel obstruction which required resection, complicated by peptic ulcers that bled, etc.  She was in the hospital for 3 weeks, followed by 19 days in TCU prior to admission at our facility.  The other was admitted for acute, severe CHF exacerbation, and had a pretty severe psychotic episode during the hospital stay.  They are both receiving PT and OT and slowly improving.   Both have very challenging personalities and even more challenging families to deal with.    Like I said, these ladies had been scheduled for cataract surgery before all the acute stuff happened. The ophthalmologists postponed the surgeries pending the resolution of the acute illnesses.  Well, now, both of the families are demanding that we schedule the office visits and cataract surgeries.  I have tried explaining the rationale of waiting until the other processes have resolved, and that these procedures are not related to the hospital stay, etc.  Both families have interpreted my stance as suggesting that the facility just doesn't want to pay for the procedures. (well, okay, that's part of it)   One of them said, "The money is not an issue. We will pay for this. We want it done now."   My BOM looked up the HCPCS that we got from the ophth and says they are not excluded.    So, what are we supposed to do?  When I did vision RAP on both of these, neither seemed to be significantly impaired in daily activities due to their vision. One of them has already had one cataract done, and the vision in that eye is almost perfect.  The other one also has glaucoma, but was able to read all sizes of newsprint (including the tiny little print on the bylines) with her glasses on.  If I felt that there was a patient care or quality of life issue, I would be on the phone myself to make the appointment.   But, for both of these folks, it just seems like a really poor use of our limited resources to pay for these procedures, just because they are in their Med A stay.   Any ideas?  Any regulations or sources I could use to back up my position and not look like a big meanie?    Thanks!   Holly     Holly F. Sox, RN, RAC-C  Clinical Editor, Careplans.com www.careplans.com [EMAIL PROTECTED]