Who Pays for MED A items?

[CapeCodMermaid, RN]

Here's the issue: we accepted a woman status post pneumonia for short term rehab. AFTER she was admitted we found she had a non healing wound. Out she goes and comes back with orders for a wound vac. So we paid for it. But now, she has to go to the hospital for vascular studies and most likely surgery. If she stays on census (with a paid bed hold) do WE have to pay for the surgery etc? We are constantly getting bills for followup MD visits for people with new hips and knees. In my old facilities we didn't pay for those but for some reason, this facility is convinced those bills are our responsibility. Anyone know?? Talino??

[Talino]

This has to do with consolidated billing - what's included and what is not

http://www.cms.hhs.gov/snfconsolidatedbilling/

http://www.cms.hhs.gov/SNFPPS/05_ConsolidatedBilling.asp

Assumably the primary payor is Med A, so when the resident is admitted to the hospital, Medicare ceases financial obligation to the SNF. The services will now be paid thru the Medicare hospital insurance. The practice of keeping the resident in the census while on a paid bed hold is simply yours. The SNF has no other obligation but to keep the bed vacant until he returns.

If the chronic wound was present during the initial hospital stay, even though the primary dx is Pneumonia, the skilled service is not geared solely on Rehab alone. With all the interventions going on with the wound, it is definitely skillable.

[rapkeygurl]

we had a situation very similar they told us the resident had small stage 2 on the foot she was from a hospital 3 hours away we were told we had to accept her even before we saw her, ( I usually go assess at the hospital in case of a dump job) We got her and she had 3 stage 4 wounds on the foot with a bad doppler study report. the podiatrist wanted a wound vac, anyway we got her sent to a wound care facility and after that she came back to us for the skilled rehab care.

[noc4senuf]

I no longer take wound vacs as I can not afford the hit they cause financially. If that resident had been in my facility, I would have let the ordering doctor know he needed to order something else or let the family know the resident needed to change facilities.

As for going out to appointments to see specialists while on Med A, the facility is responsible for those bills. Just make sure you check your CPT coding when you get the bill and "only" pay fee screen as that is what you get reimbursed.

[CapeCodMermaid, RN]

We have ONE hospital around here. If we don't take admissions we will not stay in business...wound vac or not.

[susanthomas1954]

Do you have or use the Advance Beneficiary Notice? And, very importantly, what other payor sources might be available, private secondary, VA, IHS, medicaid in some flavor?

ST