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Many
of the items you are talking about are not Medicare Part A services- annual
mammograms are billed to Part B even if on Part A.
Medicare does not
cover eye exams and glasses therefore the SNF is not liable for the
costs
Administration needs
a lesson in Medicare Part A and Part B basics
Theresa
Lang
Specialized Medical
Services, Inc.
Milwaukee
WI
----- Original Message -----
Sent: Thursday, April 15, 2004 9:57
AM
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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My
advise - stay within the OBRA intent of resident focused care, not staff or
financially focused care.
"G"
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