OpenPlacement Community > Questions > Tagged: medicare

Related Medicare Readmissions

asked March 10, 2014 | 0 followers | follow | 1 answers

For those of you who use an outside vendor to do physician level reviews of Medical necessity, if a Medicare readmission is determined to be potentially related to the previous admission, how are you billing for these stays?

Hospice Status and Inpatient Status Scenario

asked February 26, 2014 | 0 followers | follow | 3 answers

An 84 year old patient is on hospice at home for end-stage dementia. She develops aspiration and for an uncertain reason is brought to the hospital by EMS, where she is subsequently admitted with aspiration pneumonia (confirmed infiltrate on CXR). She is treated with IV antibiotics for 2 days and is discharged back home on hospice.

The patient’s insurance carrier, a Medicare managed care, says that the patient’s inpatient stay is not covered and gets billed to hospice. Is this true? The reason they give is that they are not required to cover the patient again until the first of the month. I have never heard of this.

Can anyone provide any insight or regulatory guidance into the scenario I have described above?

Admitted Patient

asked February 18, 2014 | 0 followers | follow | 2 answers

What would you do? A patient admitted for symptom management under Hospice GIP is in the hospital for several days, then decides to revoke hospice benefits….. Doesn’t meet IP criteria under Medicare for pain management….. Would you change from Hospice GIP to Medicare Observation? Give a pre-admission HINN? Any thoughts?

Cost Savings

asked January 28, 2014 | 0 followers | follow | 2 answers

We have having difficulty like everyone, being profitable on Medicare inpatients. Does anyone have any ideas of cost saving measures that Case management or Nursing can implement?

To Combine or Not to Combine..

asked November 25, 2013 | 0 followers | follow | 2 answers

If a Medicare patient left AMA, came back and then was readmitted (for the same reason) the same day as the discharge, normally this would need to be combined. However, does the fact that they left AMA change the rule? Thank you in advance for your time.

The patient won’t leave!!

asked November 4, 2013 | 0 followers | follow | 0 answers

Happy Monday everyone! Was wondering if you could help me with this . A Medicare patient placed in Observation refused to leave. It was a matter of convenience for family members who were here on vacation and wanted to finish out their tours, etc. Physician felt patient was stable for discharge, nothing else being provided to this patient that warranted an extended stay/ inpatient admit. I dodged the bullet on this one because patient did end up going home. But what should have been presented to the patient if she stayed? Correct me if I’m wrong but I didn’t think ABN or HINN didn’t seem to be appropriate in this situation. I would greatly appreciate your input!

Multiple Sclerosis Drug

asked October 16, 2013 | 0 followers | follow | 1 answers

There have been 2 new oral MS drugs recently approved, and for one of them, Gilenya, there is a requirement for 6 hours of telemetry monitoring after the first done because of the potential for bradycardia. Our neurologists want to put these patients on our neurological step down unit for this period of monitoring.

I realize that reimbursement for this may vary between payers, but how would you handle this? How would you bill Medicare for this? Medicaid?

Readmission Reviews

asked October 3, 2013 | 0 followers | follow | 1 answers

How are others reviewing Readmissions – Medicare and other payers? How much of the decision to combine or bill separately is based upon clinical judgement of reviewer and how much is based upon written standards / guidelines?

If anyone has documented standards that you are willing to share it would be greatly appreciated. At what point are you consulting with EHR or other Physician Advisor?

Total Joint Replacement Denials

asked September 1, 2013 | 0 followers | follow | 4 answers

We are starting to see discussion surrounding total joint replacement denials from Medicare. Does anyone have any experience on this and suggestions on how to ensure medical necessity for these surgeries is met prior to surgery. Exactly what is CMS looking for in the medical record?


Skilled Nursing Facility – Important Message Medicare

asked August 31, 2013 | 0 followers | follow | 2 answers

Can anyone tell me if a Skilled Nursing Facility patient requires an Important Message from Medicare? Per the CMS site and Learning Link it only says Inpatient.

Thanks so much!

We do not endorse or guarantee the completeness, accuracy or reliability of any answers, messages, blog posts or other material posted in the Community, and we do not endorse any opinions they express.