Did you know this on Humana patients?

[TigerxLiLy]

I just want to throw some information out there for the PPS coordinators just in case some are not aware:

If your humana patient had Hospice prior to entering the hospital and they enter your facility the same month as when they were on hospice at home- then your facility MUST bill Medicare instead of humana for that month.

example: mr.x was on hospice Dec 1-5 at home, he went to the hospital on the 6th due to falling. Hospital kept him only in observation. The hospital contacts the local SNF for placement. The SNF facility knows that Humana does not require the 3 day qualifying hospital stay to be accepted under humana services. However,due to being on hospice the same month as the hospitalization,the SNF facility will have to bill Medicare for the month of December. The SNF facility cannot accept mr.x at that time due to not having a 3 day qualifying stay for medicare.

Our facility did not find this nice piece of information out until we got burned 20k ... Our corporate office did not know about this..

My BOM called medicare and they confirmed that Humana has it written in their contracts.

Not sure if I wrote this where it makes sense... So just let me know.

[NRSKarenRN, BSN, RN]

That is the same situation with ANY "Medicare Advantage" insurance payer I've worked with in the Philadelphia area...

[Talino]

That is the same situation with ANY "Medicare Advantage" insurance payer I've worked with in the Philadelphia area...

I concur.

The MAO responsibility will only resume the following month, provided the skilled care requirements in the SNF are met. This is a very good "heads up" allezel!

[TigerxLiLy]

.....huh... As of now my BOM thought it was only in humans contract... I guess we better start asking questions on all our managed cares... Thanks!