Legal or Fraudulent?? Billing Question
Eric Schwelke CPO
Description
Collection
Title:
Legal or Fraudulent?? Billing Question
Creator:
Eric Schwelke CPO
Date:
1/22/2003
Text:
To all:
We have been presented with this situation:
Hospital inpatient, 94 yo female w/ hip fx. Surgery contraindicated;
patient very involved w/ other complications. Hospital wants to
discharge to SNF ASAP and Ortho orders Hip Abduction/Fx Orthosis. SNF
won't accept patient because it knows it will be financially responsible
for orthosis when it is delivered to patient in the facility. Family
absolutely wants patient to be admitted to THIS SNF. Family offers to
pay for orthosis to expedite transfer. We are a participating Medicare
provider.
Questions:
Who is financially responsible?
Is it the ordering facility (Hospital)? Because they are required to
provide whatever equipment or other items are needed by a patient during
a Part A stay.
Is it the SNF? Because the device would be delivered to the patient
during their first 100 days of a Part A SNF stay.
Can we legally bypass all of these obligations by accepting payment from
the patient/family?? The family would be notified that they could not
attempt to be reimbursed from Medicare by asking us to submit a claim
for them.
What do you think???
Eric Schwelke CPO
Reply to: <Email Address Redacted>
We have been presented with this situation:
Hospital inpatient, 94 yo female w/ hip fx. Surgery contraindicated;
patient very involved w/ other complications. Hospital wants to
discharge to SNF ASAP and Ortho orders Hip Abduction/Fx Orthosis. SNF
won't accept patient because it knows it will be financially responsible
for orthosis when it is delivered to patient in the facility. Family
absolutely wants patient to be admitted to THIS SNF. Family offers to
pay for orthosis to expedite transfer. We are a participating Medicare
provider.
Questions:
Who is financially responsible?
Is it the ordering facility (Hospital)? Because they are required to
provide whatever equipment or other items are needed by a patient during
a Part A stay.
Is it the SNF? Because the device would be delivered to the patient
during their first 100 days of a Part A SNF stay.
Can we legally bypass all of these obligations by accepting payment from
the patient/family?? The family would be notified that they could not
attempt to be reimbursed from Medicare by asking us to submit a claim
for them.
What do you think???
Eric Schwelke CPO
Reply to: <Email Address Redacted>
Citation
Eric Schwelke CPO, “Legal or Fraudulent?? Billing Question,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/220393.
