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Here
are a few thoughts on this. I believe that we do have to do a certain
amount of 'case management' to be financially responsible in the industry
today. However am in total agreement that if the services are needed and
warrented that they should be provided.
Remember, specific preventative and screening services such, as the
mammography, are excluded under consolidated billing and can be billed directly
by the provider of the service. In addition, non medicare B covered
services are also not the responsibility of the facilty, such as the eye
exam. If the daugher is insistent on the eye exam, they can be billed for
the service instead of the facility.
As you
can see, many questions need to be raised and answered in determining how to
proceed with services provided. In some cases, it may be appropriate
to see if the ordered test/procedure/service can be deferred. This is a
case by case determination and should not be a misconstrued as a blanket
statement.
Knowing all the ins and outs of consolidated billing is key to the
facilities success.
Ron
-----Original
Message-----
From: Heidi Ebertowski
[mailto:[EMAIL PROTECTED]
Sent: Thursday, April 15, 2004
8:58 AM
To: [EMAIL PROTECTED]
Subject: Medicare A
resident's/Prospective Payment System
Wondering what others are doing in
relation to Medicare part A resident's. We have been instructed by our
CEO and DON to manage our part A resident's. They are not to be sent to
labs or appointments unless it is related to their part A stay. In other
words, residents that are here for PT and OT for a hip fx are not to have
their annual mammograms, eye exams, etc... cuz we eat the cost. The
problem I have is that I feel that sometimes these tests need to be
done. For example, what if the resident has a hx of breast cancer and
has had a mastectomy and it is recommended that she have a mammogram every 6
months. Well, if she's medicare part A for PT and OT then it is not
"allowable". What if my decision to put off the test, results in
not detecting a cancerous tumor. I don't know about you but that makes
me un easy. Another example is a resident who has been having problems
with her vision and has a dx of diabetes. However she is here for
Therapy. Daughter is insistent on eye exam. Our facility
says no way she can wait til she's off Medicare part A. What if our
decision to halt tx to the eye doctor results in permanent eye damage??????
(I did end up sending this resident and she was dx with retinal
hemmorage). I just feel like it should be explained prior to admission
that these things would not be covered but the family/resident should have say
in negotiating a decision. It's their health. I agree that people
shouldn't take advantage of being on part A like getting new eye glasses,
having all their labs checked just to see, or having tests that are not
necessary and could wait til their off part A but there is always the
exception of the resident who does need the labs, the mammogram, the eye exam,
etc....Any insight would be appreciated.
Heidi
Ebertowski,R.N.
MDS
Care Coordinator
Valley
Memorial Homes
Grand
Forks,
ND
(701)787-7937
fax (701)787-7901
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