Can a nurse get in trouble if....

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I work in a facility where one side is sub-Acute & the other side is SNF. I know that patients that are admitted into the subacute unit are patients with a tracheostomy. The census (# of subacute residents) at the facility I work at has been low & it has affected the employees hours (the lower the census the lower the employees hours) As of next week, my facility will be adding SNF patients who have NO tracheostomy & do not have any respiratory problems and they would admit them to the sub Acute unit as sub Acute residents. Again, they're suppose to be SNF residents, NO Acute (in my perspective) I'm a new nurse and I'm confused and I'm wondering, can they do that? Is this legal?? Is this frowned upon?? Has this scenario happened else where or is it just at this facility that I work at??

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Specializes in Medical-Surgical/Float Pool/Stepdown.

What do you think hospitals have to do when they have more surgical Pt's than they do beds...they put them on medical...or cardiac...or neuro...or...

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I see what you're staying. The other problem here as well is... They're not over booked on the SNF side...

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Specializes in Pediatrics.

It's been awhile since I have worked SNFs but having a trach dosent always make someone "sub acute"

Heck people live at home on trachs just fine

Now someone may need more complex medical needs than a SNF

Complex wounds, multi system issues needing more nursing care and therapies

How can you be so sure that your facility is billing for a "sub-acute" vs SNF type of bed?

That is all on ICD10 codes and billing

Your title says "can a nurse get in trouble"

Do you think your facility is committing insurance fraud?

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Specializes in Medical-Surgical/Float Pool/Stepdown.
I see what you're staying. The other problem here as well is... They're not over booked on the SNF side...

Yes but usually every floor or facility has what they call a "sweet spot" on their census where they have just enough Pt's to not be losing money so this may be why you're getting peeps out of your norm.

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That is exactly my concern. As for billing, I'm in the dark on that one. I'm not sure how they're billing these patients and my facility has a not so good rep. We're 1 out of 5 stars.... If that helps. Them committing insurance fraud wouldn't surprise me or anybody else to say the least... I'm unsure if they're doing so, but the thought frightens me.

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Specializes in Complex pedi to LTC/SA & now a manager.

Your concerns are misplaced. Discharge from acute rehab or acute hospital = subacute. Trach can actually be SNF.

Are you coding or billing? If not, it's not your concern.

Your comprehension of what determines SNF vs subacute seems to be erroneous.

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Specializes in Cardiac, ER.

I'm confused as to why only patients with trachs are admitted to sub-acute? What does the trach have to do with the designation of sub-acute vs SNF? People with trachs live at home, drive cars, have full time jobs etc. And of course there are many many other things that could require sub-acute. What exactly is your concern?

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I discharge patients daily to subacute care...maybe one patient in over a year that had a trach, the rest did not. Does your facility have some sort of policy that prohibits non-trach patients? Do you not feel you are adequately trained to take care of the non-trach patients that are admitted (i.e. acuity too high for patient load)? The only way I can see that you can "get in trouble" is if you accept care of a patient that you can not safely care for. Maybe reviewing the definition of subacute would help ease your mind.

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Are you coding or billing? If not, it's not your concern.

This. There are so many things a nurse has to get in trouble for, but facility billing practices isn't one of them, thank God!

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Specializes in Nursing Home.

I'm an LPN and I've worked LTC/SNF all my short career. Never worked LTAC/Sub Acute but have many fellow nurse friends and family who have. I can say that I have had a few trach patients who were stable in long term care. I've also had to give report to a nurse at a subacute facility to inform her that we would be transporting an ambulatory A.A.O. X3 resident who is normally independent with ADLs to the sub acute facility for a sacral decubitus.

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You probably do not have to worry about this. People who bills, places patient have to follow criteria given by insurance and that is their problem if they are committing fraud. Health care is still a business and have to balance out the income and expenses so you are having to see this change.

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