SKILLED NURSING HOME PROSTHETIC COVERAGE
Mike Rieth, LPO
Description
Collection
Title:
SKILLED NURSING HOME PROSTHETIC COVERAGE
Creator:
Mike Rieth, LPO
Date:
8/13/2013
Text:
Dear List,
Yesterday we were hit with a recoupment from Medicare for a prosthetic limb that was placed on a patient that was living in a skilled nursing facility. Naturally I was astonished! Prosthetic limbs are a covered procedure while patient is in a nursing home. Connolly Healthcare, with their infinate wisdom, have/had (?) edits in place that were going after these Nursing Home claims. So, beware!!
Well, I had to get management on the phone and personally send them the chapter and verse in the Skilled Nursing Home Manual,
chapter 5, that states ...Prosthetic Limbs are indeed covered and payable while the patient resides in the nursing home. I cannot for one minute fathom how Connolly Healthcare is auditing our claims and they don't even know what is covered and what is not. I am going to try and get a hold of someone that can look further into this and hopfully stop any future rediculous recoupments.
When I got the recoupment in the mail, I, immediately called Medicare Reg C, and the first thing out of their mouths were, you'll have to appeal. Well, I was not happy with that as you and I both know, the appeal process can take years, I wanted this fixed from the get go, so none of us have to be subjected to incorrect audits and recoupments any time soon.
Best wishes to all!
Nancy McKay
Director of Reimbursement.
Yesterday we were hit with a recoupment from Medicare for a prosthetic limb that was placed on a patient that was living in a skilled nursing facility. Naturally I was astonished! Prosthetic limbs are a covered procedure while patient is in a nursing home. Connolly Healthcare, with their infinate wisdom, have/had (?) edits in place that were going after these Nursing Home claims. So, beware!!
Well, I had to get management on the phone and personally send them the chapter and verse in the Skilled Nursing Home Manual,
chapter 5, that states ...Prosthetic Limbs are indeed covered and payable while the patient resides in the nursing home. I cannot for one minute fathom how Connolly Healthcare is auditing our claims and they don't even know what is covered and what is not. I am going to try and get a hold of someone that can look further into this and hopfully stop any future rediculous recoupments.
When I got the recoupment in the mail, I, immediately called Medicare Reg C, and the first thing out of their mouths were, you'll have to appeal. Well, I was not happy with that as you and I both know, the appeal process can take years, I wanted this fixed from the get go, so none of us have to be subjected to incorrect audits and recoupments any time soon.
Best wishes to all!
Nancy McKay
Director of Reimbursement.
Citation
Mike Rieth, LPO, “SKILLED NURSING HOME PROSTHETIC COVERAGE,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/235532.
