Long Term Care

Good morning all. I work with SNF's and have a potential concern and am wondering how other locations work with this.
When it comes to attending physicians, NP's and PA's providing medical services to our residents, we do not pay them directly. They do their own billing of the residents directly to their insurance/Medicare. The nursing home has no knowledge of their billing. Do other locations have a system where you do know this information and/or track it in some manner?

I was brought a potential concern yesterday that I am not sure how to investigate or potentially prevent in the future. I have NP documentation completed for service dates that don't make sense with the resident's stay. When I approached the provider they told me if I didn't like the service we could give immediate notice. It was not the response I expected.

Anyone have any thoughts or recommendations?
Do you have information about the provider's billing? Do you audit/monitor in some way? Do you have a recommendation as to next steps I could take?

Any thoughts appreciated.


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Bethanne VanderMolen
Chief Compliance Officer/Director of Risk Management
Choice Health Management Services, LLC
HICKORY,NC
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I have worked in a LTC facility that has the same situation.  MD practice was a vendor and they billed their own services.  When I had a concern, I worked with their office manager.  She/he should be notified of the concern to see where their audit assessments lie. They can do their own audits and report it back to you. If you are having this issue probably other facilities that use them have it also. Not knowing the dynamics of the situation, some MD and NP don't like working in LTC and demonstrate it.  I have had to call the medical director and asked that one of the PA's not return due to attitude to the nursing staff and thus toward the residents.  Hope this helps










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Barbara Naimark
Severna Park,MD
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Original Message:
Sent: 11-23-2022 08:32 AM
From: Bethanne VanderMolen
Subject: monitoring provider billing (MD,PA,NP)

Good morning all. I work with SNF's and have a potential concern and am wondering how other locations work with this.
When it comes to attending physicians, NP's and PA's providing medical services to our residents, we do not pay them directly. They do their own billing of the residents directly to their insurance/Medicare. The nursing home has no knowledge of their billing. Do other locations have a system where you do know this information and/or track it in some manner?

I was brought a potential concern yesterday that I am not sure how to investigate or potentially prevent in the future. I have NP documentation completed for service dates that don't make sense with the resident's stay. When I approached the provider they told me if I didn't like the service we could give immediate notice. It was not the response I expected.

Anyone have any thoughts or recommendations?
Do you have information about the provider's billing? Do you audit/monitor in some way? Do you have a recommendation as to next steps I could take?

Any thoughts appreciated.


------------------------------
Bethanne VanderMolen
Chief Compliance Officer/Director of Risk Management
Choice Health Management Services, LLC
HICKORY,NC
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