Home Health Prospective Payment System Consolidated Billing

kunkelgwkunkelgw
edited April 2017 in Oasis General
After viewing all the information on this subject, we understand our agency responsibility. The question is what does anyone else do in the situations where you are not aware of services scheduled for patients until they happen or until you receive a bill. We have a bill for the video of a swallow study but the x-ray was paid (this was probably tied to a physician). Also pool therapy or hydro therapy is becoming a more popular modality for some of our patients who are obese with open wounds. Any strategies out there that agencies use? We are not contracted with anyone for services and provide OT,PT, SLP and SNV ourselves. Does anyone initiate discussions with physicians for these services? What if it is ordered by another physician and not the PCP that signs our POC?

Any and all thoughts are welcome.
Thank you,
Gwen

Gwen Kunkel BSN RN PHN | RN Lead Coder and Quality Review | CentraCare Home Care and Hospice
320-240-3264 | kunkelg@centracare.com


"Every job is a SELF-PORTRAIT of the person who does it. Autograph your work with EXCELLENCE"

Comments

  • JanRNJanRN
    edited April 2017
    According to what I have read is that you are not responsible unless you have approved it.

    Jan Fulfs, RN, BSN, President
    American Home Health
    1660 N. Farnsworth Ave., Suite #3
    Aurora, IL 60505
    Phone: 630.236.3501
    Fax: 630.236.3505
    Jan.fulfs@ahhc-1.com
  • Barbmacrn@gmail.comBarbmacrn@gmail.com
    edited April 2017
    I agree with jan. You are not required to pay for services that you were not aware, negotiated and approved a rate. You can negotiate treatment with the md to include what you can reasonably provide in the home to care for this type of wound. However, depending on how you want to manage relationships, you could negotiate for a medicare cost rate and pay the bill. Also, if the patient is getting wound care as an out patient, you could discharge unless there are other care needs home care is managing. Barb
  • loramayes@hotmail.comloramayes@hotmail.com
    edited April 2017
    You are not responsible unless you agreed prior to services rendered.
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