Assistive Living Billing

Nurses General Nursing

Published

Can someone tell me the process an assistive living goes through in billing it's residents? My husbands mother keeps getting informed that her mother's "Levels" are increasing, causing a significant raise in her bill. I do not see a big change in her condition and they certainly are not doing any extra for her. I suspect some billing fraud and want to know what to look for when I audit her chart.

This is in Ohio, if that matters much. My poor mother in law is at her wits end because there is only so much money left for her care.

thanks,

Laura

Something that may be of use to the OP:

Looks like Ohio has an elder care ombudsman program - I don't know all that much about it or how effective it is, but here's a link to it: http://aging.ohio.gov/services/ombudsman/default.aspx

I do know that the one here was sort of iffy (sided with the facility more often than not - had to point out what they were advocating was a violation of state law), and that there are regulatory agencies that determine at least to some extent what facilities charge & when they can do rate changes (at least in California.) Had the quasi-pleasant experience of dealing with them when I managed my late mother's care, 'cause it turned out that my mother's caregiver in the RCFE she was staying at didn't inform us correctly & insisted we were entitled to a partial refund. Had to inform them that (a) the money was already paid in "good faith", and (b) the refund would in all probability nail my mom right in the "share of costs" corner and in all likelihood cost her her MediCal benefits.

And people wonder why family members caring for elderly relatives tend to be kind of goofy at times...THAT I don't miss a bit! Best of luck, and let us know how it goes for you!:lol2:

----- Dave

There may be no such thing as a stupid question; but there sure are a lot of inquisitive idiots. No time for sanctimonious, holier than thou, hypocritical Ignorant orifices!

Guilty!:lol2:

----- Dave

The CBRF/ALF I work at charges by level of care. Example: if your MIL was living at our facility and needed more than an alotted amount of time (I believe its 15-20 min) of nursing care than she would be charged for that. Or if she had a new tx or eye gtts she would be charged per our facility's rates. if she is needing more help with ADLs on a regular basis she would be charged for this as well. We give our residents a copy of our charge sheet with any new charge.

It might be possible that she might be needing more care than she is letting you know. We have had that with a few of our residents. Ask the facility manager about it and express your concerns. The CNAs sould be charting daily on what cares are being done for your MIL. We have even gone as far as having our aides writing their own naratives of every visit they made to a room to help the family see that extra care is really needed.

I hope that you are able to get your questions answered and everything worked out.

Specializes in Telemetry, Orthop/Surg, ER,StepDown.
Guilty!:lol2:

----- Dave

Lol!but you can admit it which almost turns it endearing

:yeah:

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