reimbursement

[Chris Cavanaugh]

The LTC facility can only “bill” for VAD placement IF the patient has private insurance and the line is placed by the facility staff. Many LTC facilities have contracts with pharmacies to provide “IV backup”. This is when the LTC facility calls the pharmacy, who contracts with an agency to go to the facility to place a line.  The agency is paid by the pharmacy.  The pharmacy either bills the LTC facility directly, or, more often includes it in the facility contract as a “service”.  The facility must accept prospective payment for Medicare patients, which used to include their medications, now that is carved out under Medicare D.  They can add the VAD to the MDS to increase the prospective payment category, but they cannot issue a “bill” like hospitals, MD offices or ambulatory centers can. So, the short of it is, the payment to the agency comes out of the pharmacy’s pocket most often, sometimes out of the facility’s pocket, but indirectly.    There are some LTC facilities who will contract directly with an agency, but most prefer to stick the costs on the pharmacy, and the pharmacies offer it in order to get their business.   Chris