Direct billing for hospital patients

Direct billing for hospital patients

Steven L. Fries, L.C.P.O.

Dear Colleagues:
  I have recently approached several hospitals to apply for privileges and
have been advised by both of them that they will no longer issue or honor
purchase orders for any prescribed orthotics or prosthetics for their
patients. This new policy will evidently apply to all patients, whether they
are covered by Medicare or managed care contracts/private insurance. The
hospitals are requiring that any orthosis or prosthesis ordered by the
attending physician not be applied any earlier than two days prior to the
patients discharge and that any application be referred to as a fitting or
for training. They are insisting that practitioners bill Medicare or the
patient's insurance company directly for any medically necessary items or
services provided. The date of service on our claims must then coincide with
the patients date of discharge. I present several questions for your
consideration and invite your comments and replies.
                 1) Aren't items that we would provide covered under the
hospitals DRG's? 2) Are the
hospitals attempting to deflect their responsibilities for payment to O & P
firms, who may or may not be participating providers of a patients plan or
who may be denied payment from Medicare for services provided in good faith?
3) Are these new policies permissable under Medicare's guidelines? Is this
legal?
4) How would weekend consults be handled with insurance offices being closed
and unable to provide approvals?
5) How might the critical care patient or one with multiple diagnoses be
attended to? Indigent patients?
6) Can anyone cite any specific Medicare regulations permitting or
prohibiting these policies?
7) What experience has anyone had with situations such as these? What
effects is this arrangement having on those who are operating under these
policies?
8) How would this affect our relationship with the physicians with whom we
have worked?
  I understand a hospitals need to control costs and increase profits, but
have to wonder if this is a workable arrangement. I foresee a lot of
problems, including extended stays and complications arising from a
practitioners inability to provide a prescribed item. Please share your
thoughts, opinions and experiences. If there are any Medicare
representatives or case managers in our audience, possibly they would care to
offer some advice. Thanks to all who respond with comments and suggestions.
Best Regards,
Steven L. Fries, CPO, (L)
Fort Myers, FL