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Many
providers are confused about Consolidated Billing, just because they send us a
bill does not mean it is our responsibility. I received an invoice today
from a hospital and the resident was on Medicaid during the time the services
were provided. We simply call the provider and explain to them the
regulations and who they should be billing.
Under
Consolidated Billing, routine services and those services normally billed to
Part B are part of the daily PPS rate, with some exceptions. As Theresa
stated below, eye exams are not a considered 'routine' and are not covered by
Part B, so they would not be the responsibility of the SNF. In addition,
mammograms are on the excluded list so would not be the responsibility of the
SNF either.
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
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Statement:
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you.
-----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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