Re: SNF Help

Re: SNF Help

Morris Gallo

6/10/1999

Jake brings up a point that we need to monitor. If you have documentary evidence
that SNFs or hospitals are denying or restricting services this needs to be
brought to the government's attention. Evidence means you can show names, dates,
Rx, outcomes, not just I heard so-and-so did this. If the service was provided
by a less then qualified individual their name and company would also be helpful.

I would appreciate if everyone on the list would save my email address and send
me a copy of any info you may have of this nature. I will tabulate and present
to appropriate authorities.

Thanks
Morris Gallo, CPO



Jake Wood, CP wrote:

> ABC Practitioners,
>
> If anyone can give me some help, I would greatly appreciate experienced
> advice.
> My new patient was residing at an assistive living status which meant I could
> bill under Part B. The patient has reasonable secondary coverage after
> Medicare.
>
> My patient signed an agreement, in which I could bill under part B, with me
> not accepting assignment. The patient has a contractual agreement with me.
> The insurance coverage is between the patient and the health insurance
> company.
>
> Two days before my patient is to have his preparatory delivered, he is back
> in the hospital(the prosthesis is finished). The family is trying to arrange
> residence at a Skilled Nursing Facility (SNF). Which is without any question
> the right place if the patient needs that level of care.
>
> The hospital may not want to provide a purchase order (the hospital pays me),
> which is required by Medicare Law if I provide the prosthesis while he is in
> the hospital. Medicare also requires I obtain a purchase order from the SNF.
> So, when the patient resides at a SNF and the SNF wants to pay me 10 cents on
> the dollar. Is my only option to send my bill to collection? The patient has
> a contractual agreement with me. And if I get paid after collections, I still
> cannot provide the prosthesis to the patient (while they reside in the SNF)
> do to Medicare Law.
>
> One option is to deliver the prosthesis in the parking lot, after he leaves
> the hospital on his way to the SNF. You may laugh or find this disgusting,
> but I believe it is legal. By the way I won't stoop that low.
>
> I had another patient recently, in which the SNF wanted me to provide a
> direct formed preparatory prosthesis (CHEEPER) . By now the SNF has found
> another provider to give poor care to this patient. I also expect this
> patient, later, to come to me for a preparatory that works and or a
> definitive. The prosthesis that the SNF wanted me to provide; I stopped that
> level of poor care 15 years ago. I almost consider that level of care
> malpractice. I consider my highest responsibility is to the patient. I
> consider this medical system horrific. I also believe the worst is about to
> come.
>
> I actually am looking for constructive suggestions so I can provide excellent
> care to all my patients. I am discussed with the fact that no one cares about
> quality prosthetic care from qualified practitioners. I know that not all ABC
> practitioners are great, but let me tell you, your chances of being fit
> correctly by an ABC practitioner is much greater.
>
> Sincerely,
> Jake R. Wood C. P.