SNF Help/Thanks to everyone
Jake Wood, CP
Description
Collection
Title:
SNF Help/Thanks to everyone
Creator:
Jake Wood, CP
Text:
ABC Practitioners,
I recently ask for advice on a difficult situation concerning a new
patient/SNF. I wrote:
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.
Thank you all for your suggestions. Let me share a few comments.
1. Many suggested I try and recruit the family and have the hospital give me
a PO#, while he is in the hospital. That is exactly what I did. The hospital
did provide the PO# and the patient received his prosthesis today.
2. I opened my own practice in January of this year. I contacted Medicare
Region B and they informed me as of December 1998 a new ruling was sent out
in the periodic bulletin that Medicare sends out. I was told an inpatient
(Medicare) can receive their prosthesis within the last two days of their
stay (in the hospital) and you can bill under Part B. Only if they are going
home. If they are going to a SNF, then you need a PO# from the SNF.
I would ask all of you to check your own Medicare region and see it in
writing before you take a chance.
3. Some suggested I have the patient sent to my office, from the hospital on
their way to SNF.
4. A comment was made that some are delivering to inpatients (before the two
day suggestions), then billing under part B. I believe these individuals are
committing Fraud. If any large corporation is encouraging this, the
practitioner can easily have sever penalties and most likely can loss his or
her ABC certification (check with ABC on that).
I want to thank you all for responding. Your response helped me and I hope
helped others.
Sincerely,
Jake R. Wood C. P.
I recently ask for advice on a difficult situation concerning a new
patient/SNF. I wrote:
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.
Thank you all for your suggestions. Let me share a few comments.
1. Many suggested I try and recruit the family and have the hospital give me
a PO#, while he is in the hospital. That is exactly what I did. The hospital
did provide the PO# and the patient received his prosthesis today.
2. I opened my own practice in January of this year. I contacted Medicare
Region B and they informed me as of December 1998 a new ruling was sent out
in the periodic bulletin that Medicare sends out. I was told an inpatient
(Medicare) can receive their prosthesis within the last two days of their
stay (in the hospital) and you can bill under Part B. Only if they are going
home. If they are going to a SNF, then you need a PO# from the SNF.
I would ask all of you to check your own Medicare region and see it in
writing before you take a chance.
3. Some suggested I have the patient sent to my office, from the hospital on
their way to SNF.
4. A comment was made that some are delivering to inpatients (before the two
day suggestions), then billing under part B. I believe these individuals are
committing Fraud. If any large corporation is encouraging this, the
practitioner can easily have sever penalties and most likely can loss his or
her ABC certification (check with ABC on that).
I want to thank you all for responding. Your response helped me and I hope
helped others.
Sincerely,
Jake R. Wood C. P.
Citation
Jake Wood, CP, “SNF Help/Thanks to everyone,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/211671.
