Re: home care billing ?

[Guest guest]

I'm losing money on home care since medicare fee schdule is 12 dollars less than the same amount of time in the house!

Medicare Advantage will only pay for 2 or 3 days of aid care where regular Medicare covers 5 days a week.

If you document 30 minutes of care talking to nurses or signing orders you can bill for it. I just found that out and haven't tried it yet.

But like you I just do it. It's the right thing to do.

To: Sent: Sat, November 14, 2009 6:22:09 PMSubject: Re: billing ?

and all, this issue brings up a couple of corollary questions: first of all, the matter of billing for the supervision of home care -- I have read about the C.P.T. code number, the documentation requirements, and the Medicare allowable fee, and it really does not seem like it adds up ... I have come around to just doing it, and not even bothered to submit bills. I pretty much insist on having face-to-face contact with my patients, and work it out to see them on housecall basis maybe once per month, of more often if there is something really unstable going on, or maybe every 2-3 months if there is hardly any dynamic changes. The housecall billable is really a lot of money, but it still only seems worth doing if the patient is relatively close-by, like roughly 10 miles or so. Is anybody really figuring out an efficient and lucrative way to call it in, and earn money by doing it all over the phone for these patients, while the home health

care nurses drive out to the farm ? ...

The second question bridges the gap from Jean's gripe on 11/03/09, to the issue of how poorly the hospitalists communicate with the family doctor -- on probably a dozen occasions (or maybe 2 dozen), one of my patients has ended-up getting hospitalized at the big city hospital (Kalamazoo, or Grand Rapids, 30-40 miles from my office); I often don't find out anything about it, until some Discharge Planning person calls my office, asking me to rubber-stamp the Home Health Care nursing orders. At that point, I usually don't know what the reason for admission was, much less the discharge diagnosis, what body parts got removed in the operating room, how many antibiotics it took to handle the hospital-acquired infections, what happened to the patient's mental status since I last spoke with her, how many tubes are still going in-and-out of her, etc., but I am asked to sign the orders. I have a problem with that. So, I have come around to

telling the discharge planning lady to find the hospitalist who is signing the discharge order, and have him-or-her sign the home health care orders. Often, her response is that she can't figure out which hospitalist is going to be signing that order ... Exactly -- it will frequently take me several phone calls, and a long time on hold, to learn that much. I can sometimes call my patient directly (if the patient is still able to answer a cell-phone), but if I ask her/him: who is your doctor, the answer is always the same: he/she has no idea whatsoever.

I am willing to take over the responsibility of supervising the home health care nurses, when those records are in my hands, or on my screen; better yet is when I can buzz over to the patient's home and sit on the edge of the bed, and have a talk with him/her and the family, before signing the paperwork ... (Code Questions often arise as important parts of that discussion). The discharge planning ladies don't like my attitude, I can just tell ...

Rian Mintek, M.D. -- old-fashioned, dinosaur medicine, with an E.M.R. since 2003.

So ih ave this patient who just got out of hospitla where home health was ordered but the forms sent to me and I signed Now daugther emails says patenit will be transferring to be closer to other docs though I am like family Right But too far away Grr so anyway it willnot be 60 days of time that willhave goen by-- can I bill for under the supervison of home health?-- If you are a patient please allow up to 24 hours for a reply by email/Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org