Post-Acute Care

  • 1.  monitoring provider billing (MD,PA,NP)

    Posted 7 days ago
    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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  • 2.  RE: monitoring provider billing (MD,PA,NP)

    Posted 7 days ago
    This is an interesting one.  I would be interested in others' input as well.  How did you become aware of this?  Was it the resident/resident's family?  If that is the case, you could direct them to contact the NP's office directly to discuss to see if any better dialog could be achieved for an explanation - seems like you got pretty harsh pushback for some reason.  Another option is to have them contact whatever insurance company is paying for the visit, to report a potential billing issue and the insurance company would then investigate which would probably include asking you to verify dates of the resident's stay.  My opinion only - I'm not sure how directly involved you can be since you're really not a party to the transaction, although the resident/resident's family might not understand that (visit happened at your  location, what do you mean this isn't your responsibility...?).

    Just my two cents!  Hope you have a great Thanksgiving.

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    Marie Wagner, CHC, CHRC
    Operations Manager, Corporate Compliance
    The Queen's Health Systems
    Honolulu, HI
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  • 3.  RE: monitoring provider billing (MD,PA,NP)

    Posted 5 days ago
    Edited by Bethanne VanderMolen 5 days ago
    It came to my attention through the administrator. They dropped off notes for filing and medical records was out for the holiday week. So they were given to him. He happened to look at one and thought it was an incorrect date based on remembering that patient specifically. So he thought it was a simple mistake. When he went through the handful they dropped off and found five he reached out because he wanted to ask me if he should put them in the record.

    I told him we'd reach out to the provider. They responded in such an odd way though.

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    Bethanne VanderMolen
    Chief Compliance Officer/Director of Risk Management
    Choice Health Management Services, LLC
    HICKORY,NC
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  • 4.  RE: monitoring provider billing (MD,PA,NP)

    Posted 2 days ago
    Good morning! In my last position with a chain of SNFs, we had a similar issue in two facilities. As you mentioned, we don't pay these providers, and often our provider pool locally is limited, so some of these providers seem to think this means they can do as they wish.

    What we ultimately decided to do was to document communications with the provider regarding the discrepancies between the notes and dates of stay (verifiable facts that could be reproduced). When we did not see a change, we took the issue through our QAPI process as a trend in inconsistent physician/NP documentation.

    This gave the internal team a chance to discuss this with the Medical Director while documenting that the issue was noted and addressed to the best of the facility's ability. Eventually, these bad notes proved to be the tip of the iceberg of issues with the providers (timeliness of visits, response to orders/inquiries, etc.) and the provider's relationship with the facility was terminated.

    One additional question for thought - what sort of provider privileging process does your facility use? You might look at the contract or related documentation and see if it needs to be updated to include language about these types of issues. We included this in our updated process when we underwent Joint Commission Certification.

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    Kelly Cooper
    Compliance Specialist
    UFH Shands
    Gainesville,FL
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