Original post
>>>>It is has been my understanding that O&P services in Rehab. Hospitals or
in designated Rehab.units in hospitals have been DRG exempt, and services are
covered under Part B. Recent conflicting reports from colleagues state that
Medicare is now treating them as SNF’s (skilled nursing facilities), and
applying such rules…(i.e. provision after discharge…exhaust Part A…training
purposes..etc)…and sometimes requesting overpayments for past services
provided.
As usual, conversations with Medicare cannot verify this. They are not sure
and have to investigate. Has anyone had feedback on this, or experienced
problems. Thanks in advance B.R. CPO <<<
Here are the few responses received. Subsequently, followup with the
hospitals proved this to be true. The Rehab. units/Rehab. Hospitals are now under a
PPS (prospective payment system) method of reimbursement....the same as SNF's.
They are allotted a more liberal schedule of patient treatment modalities,
therapy, rehab, length of stay....etc....but reimbursement is the same. Bottom
line is the hospital has to pay for the O&P services not covered in the SNF
guidelines established by Medicare....i.e orthotics and specific prosthetics.
Thanks for the responses
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Prosthetics (except soft goods) can be billed to the DMERC under any
circumstances. Orthotics must be paid for by the facility if the patient is
in a part B bed within their 100 days.
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My understanding is that it doesn't matter if the hospital/facility is
DRG exempt. The patient is still considered to be in the hospital and
is covered under Part "A", which makes the facility fiscally
responsible.
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hello we are in louisiana and are having a major problem with this. medicare
is requesting there money back for overpayment from patients from last june
and july. i spoke with medicare about this and they suggested that i file an
appeal and maybe i can keep some of the money. what is happening is that the
nursing home is moving the patients from skill to nursing during there stay. it is
a battle that i just started fighting two weeks ago. i have to figure out
away to get the nursing home to bring the patient to my office for reinbursement
instead of del. in nursing home. if i get anymore info., i will forward it to
you.
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C> onversations with MC will only frustrate you. The manual is meant to be
> vague. I’m not able to recite the paragraphs but I interperate it this way.
> My understanding of MC “B” coverage for Orthotic service were we bill the
> DMERC is that the person but have been in the facility for 100 days. And even
> that is vague.
> Rehab hospital, rehab floor makes no difference. The manual states the item
> can be delivered 48 hours prior to discharge for the purpose of training by
> the provider to the patient on how to use the item. It is not to be worn in
> the facility for any other purpose except for training. It is for use at
> home wherever home may be and the patient’s discharge is not predicated upon the
> delivery of the item in the facility. Because the provider has the option
> of fitting and training of the item at the facility and delivering the item at
> the patient’s home.
We are asked numerous times to provide services in a lucrative market to
MC’ers by a local hospital. Most of the time we have to turn them down because
the situation does not pass the test. A competitior down the street smiles all
the way to the bank because he does provide the service. I always suspected
he did and it was confirmed by the hospital staff. I have tried to contact MC
so that they could investigate what I consider to be fraud but they do not
seem to care. My evidence is overwelming. So I guess you can roll the dice
and provide, refuse and hope that someday MC will read their own manual and go
after the fraudulant billing or make clear exactually what they intend the
regulation to accomplish.
If anyone who reads these words knows the correct person to contact regarding
MC fraud let me know.
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This has been a problem in my area also. A lot of rehab depts these days
are being licensed as SNF’s (probably for some beneficial fiscal reason),
but my experience is that they will tell you how they are licensed if you
ask their director of nursing.
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