Medical Supplies Question

shrinky · Jun 27, 2008

According to the Hospice Benefits handout, we have toprovide supplies necessary for the care and comfort of the patient. It does not specify just needed for the terminal diagnosis as it does with medications. We provide all needed supplies for Medicare patients. Does anyone have any other information on this subject?:heartbeat

shrinky · Jun 27, 2008

Now I have to correct myself, having been corrected gently by my boss. We only have to supply those medical supplies related to the terminal diagnosis. So I think you would have to decide if one is related to the other. I hope I haven't confused you.:heartbeat

doodlemom · Jun 28, 2008

I would have to ask why the patient is requiring pleuryx kits. Why does he have fluid in his lungs? Does he have lung or liver mets? If you can find a reason that is directly unrelated, then you would not have to pay for this. I can't imagine that there are too many people out there who require pleural drainage and it is not related to their terminal diagnosis.

tencat · Jun 28, 2008

Is it considered aggressive treatment? I'm thinking that technically if it's not related to the terminal diagnosis directly, then it doesn't have to be covered by the hospice. BUT if it's not directly related, then their insurance should pick up the tab for that? It is a confusing world out there in Medicare/Insurance land.

leslie :-D · Jun 28, 2008

It is a confusing world out there in Medicare/Insurance land.

it certainly is.

from the Centers for Medicare & Medicaid Services

http://www.cms.hhs.gov/center/hospice.asp

i'm sure your answer lies somewhere therein.:chuckle

leslie

AtlantaRN, RN · Jul 2, 2008

I was not correct, his primary is lung cancer and the catheter is in the pleural space. Thing is, my administrator is trying to get ME to get the mans Psych doc to admit him under "advanced dementia", as patient has an extensive psych history..... I may not know everything, but I do know that Lung Cancer will kill him faster than his advanced dementia as patient is still able to feed self....

I don't like this going in the "back door", for referrals. for example: marketer will go to assisted living facilities, talk up their administrators, and the administrators give the marketer the patients name and poa's name....then the nurses are supposed to go get an order to really "evaluate" the patient..... I thought marketer gets a referral from a DOCTOR, then we go from there.

What do you all think? Any help is greatly appreciated. I have 15 patients, and the last couple of days 3 were declining rapidly, and all I get from the office is "do you have an order for patient X?

linda

doodlemom · Jul 2, 2008

I have seen some hospices that have similar ethical/questionable admission practices. Some of the large chains can get away with this most of the time because they can afford to pay a huge fine (one of the national chains had to pay a 14 milllion dollar fine in 2006 and it did not stop these practices.) Your patient is obviously dying from cancer and your hospice would be required to pay for pleuryx drainage if you took him as a patient. Any physician that is willing to state the patient is dying from dementia would be putting his/her license on the line. If your hospice practices this way, I would look for another job.

Anyone can give a referral for hospice, so it is perfectly legal for the facility to give a marketing person a referral without a doctors order. Hopefully the facility is talking with the families before the referral is given and the administrator is not just randomly going through charts to give name and numbers of pts/families (that would probably not be legal.) I have heard of marketing people going through facility charts to identify patients they think might be eligible - that is not legal.

aimeee, BSN, RN · Jul 2, 2008

I was not correct, his primary is lung cancer and the catheter is in the pleural space. Thing is, my administrator is trying to get ME to get the mans Psych doc to admit him under "advanced dementia", as patient has an extensive psych history..... I may not know everything, but I do know that Lung Cancer will kill him faster than his advanced dementia as patient is still able to feed self....
linda

The physician must certify the patient under the diagnosis that is the one that appears most likely to be driving the terminal process. End of story. Anything else is unethical. If its a toss up I am fine with choosing the one that is financially most advantageous, but this case sounds like it is pretty clearly misrepresentation, which would be, MEDICARE FRAUD.