Re: medicare policy in LTC Originally Posted by fuzzball I never knew that a patient who was on medicare could not go out of facility overnight. Out of 39 patients I had one pt. I never saw a policy or procedure on this account. Never worked anywhere else. Here is the situation:
The other night pt dtr came and picked her up. I gathered her meds,etc. Did the documentation. Done deal. Yesterday, management didn't have the guts to tell me, but dayshift nurse told me that pt is off medicare because she went home overnight. So when the dtr returned last night, I told her what happened. I took responsability for not knowing the policy.(even through the policy is not on the unit or anywhere else for that matter) The daughter told me that she did not even know that her mother was on medicare. She thought she was on title 19. Who's job is it to tell family members what status there payment, etc. in this type of situation.
Someone *really* needs to understand Medicare in your facility, and it doesn't sound like anyone does. The fact that the resident went home overnight doesn't automatically mean she's off Medicare. It does affect the PPS calendar, and there needs to be a documented reason why she was allowed an overnight pass, but by itself it's not a reason to kick someone off Medicare. And if someone is dropped from a Medicare A stay, the resident and family are required by law to receive official written notification, and to be advised of their right to appeal the decision. Someone in your building--whoever manages PPS from a nursing standpoint, probably the MDS coordinator--should have been monitoring the Medicare residents and should have known that the LOA was planned. I have told families that they could not take their loved ones for overnight visits or even non-therapeutic afternoon visits while they were on Medicare. (I tried to be reasonably lenient in the interpretation of non-therapeutic, but I wouldn't accede to Medicare fraud.) If the family insists, then they are told right then and there about the consequences as far as Medicare coverage.
Sometimes the family is not aware they are on a Medicare stay, especially if it's a long-term resident who's now on a short-term Medicare A stay because of a hospitalization. Once the Medicare exhausts or they go back to unskilled, they go back on Medicaid or whatever their primary payor source was. Unless they were private pay, the family doesn't even notice the difference.
Never would I have expected the floor nurse to know about this or to discuss it with the family. However, for future reference and to make your life easier, you should always alert someone in management if you have a resident planning an overnight. It affects billing, whether or not they are on Medicare.
Search Tags
Billing should have told the daughter about this rule on the day of admission. It's certainly not a nurse's fault for not knowing this billing policy.
I'll have to find out the answer sometime in the fall when I go back to work.....But it makes sense to me-Med A is skilled so an LOA seems unreasonabe at that time. Some inservice time is a good idea...Our RNAC staff post a list on every unit of the current Medicare A residents and their dx...This has been invaluable because we have alot of agency staff and float staff......We also have rules regarding LOA-we must have 48 hours notice because we have to order the meds from our pharmacy-we are not permitted to pull them from the resident's stock ....We never have families just running in to pick up mom or dad for an overnite...Don't beat yourself up over it---the blame here can be spread,I think.....
Nursing News