Wiki Transitional Care Units?

[jfeight]

Looking for information on how Transitional Care Units (within facilities) are reimbursed. My understanding is they are paid a per diem, but is this correct? What happens if a patient needs care that the TCU cannot provide. For example--can a TCU discharge a patient to a Wound Center for care on a particular day, and would that Wound Center be reimbursed? What if the Wound Center was part of a different facility?

Are there any inclusion/exclusion/carve out lists for TCUs that we should reference--not finding much via google or on CMS.gov.

Thank you!

Jennie

 

[thomas7331]

Assuming the TCU is credentialed as a SNF, the reimbursement would be made under the SNF PPS system for Medicare patients, or by your payer's contractual terms. Usually this is a per diem rate, adjusted base on the patient's case mix. Services provided by entities outside of the facility, including most wound care services, are governed by SNF 'Consolidated Billing' rules and are included in the per diem rate. The wound care center would bill the SNF for those services, as those are included in the SNF reimbursement rate and Medicare will not pay them separately if the patient is in a covered SNF stay. You can find a list of the specific services that are excluded from consolidated billing as well as other related information on the CMS web site related to SNF reimbursement here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/index.html. If it is not a Medicare patient though, the rules for this may depend on the payer's policy and/or the facility's contract.