Assistive Living Billing

[Laurab14]

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

[R.Williams]

I am not exactly sure how it works but I did find these websites that may help you out or give you something to go by!

http://www.canhr.org/RCFE/rcfe_costs.htm

http://www.longtermcarelink.net/eldercare/assisted_living.htm - scroll down to COST!

Hope this helped you some!

[mindlor]

Typically nurses are not involved in billing whatsoever so idont think you will get much response here......

[Laurab14]

I did get a few suggestions. I posted it here because I didn't know if there was a MDS type billing for case mix scores since they keep saying the documentation warrants a higher level. In the hospitals, they can't bill if it isn't documented, and wondered if it was the same in assistive living.

[psu_213, BSN, RN]

You can do some basic 'auditing,' but if you really suspect billing fraud, you should get an attorney involved. (eek, I can't believe I just said that )

[nurseprnRN, BSN, RN]

ask to see the criteria for those "levels" and then check the documentation to see if the care given matches the criteria. alas, assisted living is usually private-pay, so they can make it up as they go along, but the policies should be dated and you can correlate c her dates of care.

be sure to come armed with a signed hipaa release from your mother in case they say they can't show you her records "because of hipaa." you can download generic ones off the net, and you should have one for her anyway.

[LadyinScrubs, ASN, RN]

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

The facility should be able to provide you with the definition/rationale for each level and provikde you with the assessment they completed on the resident, which required a higher level of assistance. If what they provide does not compare with what you see, then you need to have a talk. Remember, that many in assisted living need extra assistance in the afternoons and evenings--many family members do not visit at this time and never see the resident acting out, walking the halls, being anxious/affraid, etc.

[DixieRedHead, ASN, RN]

Ask for an itemized bill and an explanation of what caused each level of care rise. Then ask what care is being provided for your MIL that caused these "levels" to rise.

If you don't get an answer, ask again, and keep asking until you get an answer you can understand.

[CoffeeRTC, BSN, RN]

No experience in AL or billing and my MDS experince is distant....

Does she need more assist with adls? Now incontinant? Wounds? Help with feeding or bathing (adls) different type of meds? maybe injections or blood sugars? Behavior monitoring or any pt education?

I'd just ask what the specific changes are in the level of care? If she has declined...don't they need to tell you? Do they have any type of family conferneces?

[traumaRUs, MSN, APRN]

This might be something better handled with the ALF where your MIL resides.

Since ALF's typically are completely self-pay, its a matter of what the market will bear as to what is charged.

[traumaRUs, MSN, APRN]

I will merge these two threads are they both discussing the same topic.

[clinicalteach]

I just started sitting down with family members for the biannual assessment of their loved ones, so that i could show them where the "point totals" that are used to determine the care levels come from. Service plans and care levels are much like the much beloved care plans. Their are actions that are being implemented to reach a goal. Sit down with the resident care director and have them go over it, point by point.