But under the PPS system, we are
responsible to tell the provider, be it the clinic or hospital that they are
part A and they bill us. We get a daily rate for the Med A patient and
everything else comes out of that lab, therapies, etc….. That’s what
I’ve been told. Maybe they do need a lesion in Med part A and part B.
Heidi
Ebertowski,R.N.
MDS
Care Coordinator
Valley
Memorial Homes
Grand
Forks, ND
(701)787-7937
fax (701)787-7901
Confidentiality
Statement:
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-----Original Message-----
From: Theresa A Lang
[mailto:[EMAIL PROTECTED]
Sent: Thursday, April 15, 2004
11:50 AM
To: [EMAIL PROTECTED]
Subject: RE: Medicare A resident's/Prospective
Payment System
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
Specialized Medical Services, Inc.
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]On Behalf Of Gail
Neustadt
Sent: Thursday, April 15, 2004
10:37 AM
To: [EMAIL PROTECTED]
Subject: Re: Medicare A
resident's/Prospective Payment System
----- 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
Confidentiality Statement:
This message is intended for the sole use of the individual
and entity to whom it is addressed, and may contain information that is
privileged,confidential and exempt from disclosure under applicable law.
If you are not the intended addressee,nor authorized to receive for the
intended addressee,you are hereby notified that you may not use,copy,disclose
or distribute to anyone the message or any information contained in the
message. If you have received this message in error,please immediately
advise the sender by reply email and delete the message. Thank you.![]()
My advise - stay within the OBRA intent of resident focused
care, not staff or financially focused care.
"G"
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