SNF-acquired MRSA - Medicare co-pay - pt advocacy

[mwhyte13]

Hello,

I have a pt who had an extended SNF stay due to MRSA acquired from the facility. Now Medicare (several months later) is billing for co-pay for the extended stay.

Any suggestions/resources for this? I know Medicare does not reimburse (or reimburses less) facilities for 'never events,' but I am wondering if pt has any recourse to avoid a several thousand dollars co-pay.

[lovinlife11]

I'm confused, if the patient contracted mrsa in the facility, why is the patient getting billed? I thought the facility absorbed the expense, after all it's not the patients fault.

[Esme12, ASN, BSN, RN]

I am curious why you as a nurse have access to what the patient is being billed or that you have contact with the patient for they have been discharged from their extend stay, yes?

SO what you are saying is that medicare is refusing to pay the SNF due to a facility acquired infection so the patient is left with a balance from the facility for the stay in the facility.

Who is billing the patient medicare or the facility?

[mwhyte13]

I'm confused, if the patient contracted mrsa in the facility, why is the patient getting billed? I thought the facility absorbed the expense, after all it's not the patients fault.

That's where I'm coming from! The expected stay at the SNF would have been less than 20 days (no co-pay) if she had not contracted MRSA at the facility. I have suggested that she file an appeals with Medicare, but I am specifically looking for help/guidance from someone who has dealt with this before.

[Isabelle49]

I think the patient or family should call Medicare and try and speak with a supervisor. Might even call the local DHH and see what their thoughts are on this.

[Isabelle49]

I would be willing to think that the OP as a nurse has access to this information because it was directly relayed to her ears from the patient or family, or maybe administration where she works told her this.