Featured question from Biller’s Talk

Source: The Biller’s Association for Long-Term Care, which includes access to Biller’s Talk, a great peer resource for long-term billers and other involved in the revenue cycle process.

Q: A patient came in from the hospital. The patient was admitted to Medicare Part A and was expected to stay, however after two hours, she wanted to go home and the physician ordered home health services. The patient didn’t sign the contract at the time of admission and didn’t sign an advance beneficiary notice (ABN). Does this count as a utilization day and should Medicare be billed using the AAA default rate?

A: Yes, if the patient was admitted with the understanding that her coverage was Medicare. A 5-day PPS must be completed in order to capture correctly on the end of year cost report. It sounds like the facility should mail the resident an ABN with a follow-up cover letter stating that “Medicare requires…” the facility to do so. The good faith and intent was there to provide her services. The resident’s choice to discharge was her own and the physician supported this decision. It sounds like you all made it the smoothest transition possible given the quick nature for which it occurred.

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