Re: SNF Help
Eric Schwelke, C.P.O.
Description
Collection
Title:
Re: SNF Help
Creator:
Eric Schwelke, C.P.O.
Date:
6/10/1999
Text:
Jake:
I am assuming from your example that the first patient and his family are
refusing to honor the original agreement to pay you directly and have you
send the bill in to Care B for them. If this is the case, and they want
either the hospital or the SNF to pay, then I would use the patient and his
family as ammunition and try to convince them to put pressure on the
hospital or SNF finance department to issue purchase orders. Since those
facilities are actually financially responsible for the device AND by laws
are actually reimbursed in their rates for the device, why should the
patient pay? I have found that in a lot of cases getting the patient
involved with his insurance reimbursement is to our advantage.
Check out this scenario:
A Trans Tib amputee is a new resident in a SNF. Patient is receiving
restorative PT for pre-prosthetic training which are considered A days.
Patient plateaus in his restorative therapy which is documented in his chart
by the therapist and attending physician. Since there is no longer any
progress until the preparatory is delivered, the patient is put on a
maintenance program, which is not considered A days (patient is now on
B). The prosthesis is now ordered, fabricated, fit, and delivered while
on maintenance. Conceivably, the device can now be billed under B. Once
the prosthesis is delivered, the patient is ready to begin restorative
therapy again and goes back on A days. Now, I don't condone this because
this is a very gray area, but the documentation is all there, and the
physician has signed it. I'm not sure how the HCFA would react if they knew
of this. It does seem like a loophole. Maybe we could get a letter
ruling or predetermination similar to the IRS?
Good luck!
Eric Schwelke, C.P.O.
I am assuming from your example that the first patient and his family are
refusing to honor the original agreement to pay you directly and have you
send the bill in to Care B for them. If this is the case, and they want
either the hospital or the SNF to pay, then I would use the patient and his
family as ammunition and try to convince them to put pressure on the
hospital or SNF finance department to issue purchase orders. Since those
facilities are actually financially responsible for the device AND by laws
are actually reimbursed in their rates for the device, why should the
patient pay? I have found that in a lot of cases getting the patient
involved with his insurance reimbursement is to our advantage.
Check out this scenario:
A Trans Tib amputee is a new resident in a SNF. Patient is receiving
restorative PT for pre-prosthetic training which are considered A days.
Patient plateaus in his restorative therapy which is documented in his chart
by the therapist and attending physician. Since there is no longer any
progress until the preparatory is delivered, the patient is put on a
maintenance program, which is not considered A days (patient is now on
B). The prosthesis is now ordered, fabricated, fit, and delivered while
on maintenance. Conceivably, the device can now be billed under B. Once
the prosthesis is delivered, the patient is ready to begin restorative
therapy again and goes back on A days. Now, I don't condone this because
this is a very gray area, but the documentation is all there, and the
physician has signed it. I'm not sure how the HCFA would react if they knew
of this. It does seem like a loophole. Maybe we could get a letter
ruling or predetermination similar to the IRS?
Good luck!
Eric Schwelke, C.P.O.
Citation
Eric Schwelke, C.P.O., “Re: SNF Help,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/211675.
