Please read this if you have a friend or family member that it Medicare eligible. It could save them from paying a bill they DO NOT OWE. I spent the day at an educational seminar on Medicare billing. On October 1st of this year (2 weeks from now), Medicare will be drastically changing the way they pay bills for Medicare services, and this INCLUDES Medicare advantage plans.
The seminar I attended was for skilled nursing rehabilitation services (i.e. inpatient therapy for a broken hip).
As with anything Medicare rolls out, it is convoluted, redundant and nonsensical. Most facilities have done little training (or as much as they could), ours was today, and we have to start documenting on it next week. The charting on skilled nursing patients has to be on point, and in many cases, if nursing and therapy services don’t document properly, even something minor can trigger a rejection.
It is the majority of facilities standard practice, or sometimes even an automated one, to issue a bill as soon as insurance or Medicare issues a denial. This means your family member could possibly receive a bill because of an error on the facility’s part, or on Medicare’s part.
Most places will try and correct the issue and resubmit, and that will generally fix the problem.
HOWEVER, there are two issues: One, if the process is automated, it may take them several days to find the issue (as I said, the process is new and convoluted), then several days for the billing department to resubmit, then several more days for Medicare to approve, if they choose not to audit the charges, if they do, it could be longer.
This leads to the second problem. My grandparents do not generally let bills sit around for long. Even if they do not pay the whole amount, they pay something. If Medicare eventually pays the claim, any payment they put toward the bill will now have to be refunded by the facility. They would have to wait for the Medicare statement to prove the claim was paid, then go through the refund process with the facility billing office. Most facilities are not locally owned, so this would likely have to be done through email or over the phone.
Our grandparents are in their late eighties and are on a fixed income. IF they even realized they overpaid a bill, they would have no idea where to begin to start the refund process. They would likely chalk it up to a loss, but for some, the money they lose could mean groceries for a week.
The process will eventually even out and become our routine, but it could take several months. Please speak to your friends and family who receive Medicare/have a Medicare advantage plan. Let them know to put medical bills aside for you to review BEFORE they pay, and to let you know if they receive ANY Medicare denial notifications. Ask them to put them aside so you can review them, and before anything is paid, if something stands out, call the Medicare/insurance office, facility or hospital and verify what was paid and what was not, and if something wasn’t paid, ask of the appeal process was initiated by the facility.
I know my facility, and most others, are educating the billing, administration, therapy and nursing staff as much as they can to make sure issues are kept at a minimum. Let’s be honest, though, it’s a new system. The rollout is going across the entire United States, all at once. Somewhere, someone has no idea what they’re doing. Somewhere, someone is going to go to work on October 1st, not having any idea what they’re supposed to do. Somewhere, someone is going to screw up royally and cause a whole lot of people a whole lot of headaches.
Also, if you know a MDS nurse, give them a hug on October 2nd. If you have some wine available, and some tissues, they probably won’t mind that, either.