Wiki SOS er and hospice unit

[aimie]

Here is interesting question

Our local hospital rents space to the hospice. Hospice does there own billing.

Presently a patient uninsured seen in ER then admitted to hospice. The hospital wants hospice to pay for the visit

Is there a way for the hospital to bill or put patient on obsevation status and then hospice can eval and then transfer patient to the unit

This is a global question each insurance is different

This could help me obtain a job

 

[jimbo1231]

Huh?

Aimie,

I'm trying to sort out the scenario you are presenting. It sounds like;

Patient has en ER Visit

They are then admitted to a Hospice that rents space from the hospital

The hospital wants the hospice to pay for the ED visit

And you are asking (I think), can the hospital put the patient in Observation and bill Observation before referring to the hospice...not sure on this part

And then the Hospiceevaluates the patent (in Observation?); and transfers to the unit (Hospice)

And a job depends on the answer to this wacky scenario?

Anyway I would ask you to clarify the scenario first. But I'll take a crack at giving an answer.

An uninsured patient visit to a hospital ED is billed as an ED visit. There really aren't options in how the visit is billed since it is based on POS .

Certainly if medically justified, am ED pateint can be admitted to Observation. But not as a billing ploy!!!!. I don't throw the F (raud) term around a lot, but that doesn't smell right .Also I'm not sure of the advantage. If the patient is uninsured it won't matter if the service is ED or Observation. If insured Obs typically is better reimbursement than ED vsits.

The Hospital can't require the Hospicel to cover the ED vist. hospital . It smells a bit like a Stark issue of tranferring to an entity that another entity has control of, and the rerring entity the hospital than asks for payment for the referral. On top of that they have a rental arrangment. That smells bad a number of ways that would require a JD to sort out.

The only right answer that I see is the hospital or billing company for the ED bills for the ED visit. There are lots of uninsured ED patients and the hospital has to deal with it.

The Hospice bills for their services. I'm not an expert on this but hospices and nursing homes often have personnel who develop Medical Assistance coverage that might pay for some hospice services.

As to the rental agreement, there should be a contract that stears clear of any potential violations. And no payment shenanigans.

So the only right answer to that scenario is No ...No ...No. And if you do it seek legal counsel....

Jim

 

[Peter Davidyock]

Aimee,
The simple answer to your question is no.
The longer answer would take a while.

Jim,
I was going to respond in depth to this but you've covered it in a nutshell. I started reading your reply thought "he's got it, no need to respond".
I do drop the "F" bomb often. It's part of my job.
Not only would manipulating the billing for this get her in trouble but the facility is endangering themselves as well. I somewhat doubt this is facility driven and more than likely some over zealous employee trying to one up the system. Thier internal auditors will catch it I am sure.


The entire scenario sounds suspicious to me.