Question about IV's and Medicaid...

[hoolahan, ASN, RN]

I don't do IV's in homecare, but I work as a weekend sup, so if I get a referral for our IV dept, I have to deal with it. This is usually not a problem. If we take the insurance, we can take the case. Simple.

But, a question cae up this week, our med-surg nurse opened a case, to instruct in trach care. The pt also had a port w IVAB, and the referral stated the IV was being managed by a different Infusion company, being paid by a managed care company. Our services were being carevd out to straight caid. Thsi is not an uncommon thing to happen, esp if we do not accept the other insur company. So, intake thought nothing of it.

In the afternoon, I got a call from a nurse from another agency, she was in the home to do the IVAB, and said her agency was referred by the pharmacy/infusion company, and their payor source was also caid, and that caid will not allow two agencies in for skilled needs. If she had been being paid by the HMO, it would not be an issue, but she needed me to say if we were going to keep the case, we had to get the dose, due w/in the hour, covered. I knew I couldn't do that, just b/c of the way our IV services are set-up, so I had to give up the case to their agency.

So, has this ever happened to anyone else?? Is this true about Caid and IV billing? I couldn't reach the manager of infusion to ask her, but she said I made the right decision at that time w/o any other resource to go to, she herself had never heard of this being an issue.

Any thoughts?? Karen??

[renerian, BSN, RN]

This is true in Ohio. Stinks but that is here.

renerian

[Monica RN,BSN]

True in Florida Also. Medicaid pays for the Drug in the Iv but not the supplies.. The bag, tubing, syringes, IV pole .... so on and so forth.. Many cant afford that.