Should nursing homes pay the hospital bill?
What is the proper billing procedure to follow when nursing home residents are admitted to the hospital for services related to an injury? That’s the question Liz Kehrer, CHAM, manager of patient access at Centegra Health System, McHenry, IL, would like answered. In line with Medicare Secondary Payer (MSP) guidelines, she has told her staff to investigate whether the nursing home’s liability insurance carrier should be the primary payer in such cases. "Before we can bill Medicare, we have to exhaust all other sources of liability," she says.
The problem she faces is that administrators at a couple of the nursing homes she deals with say the MSP rule does not apply to them because the nursing homes are the primary residences of the people who live there year-round. She has been unable to find any clarifying documentation. "Is this true or not?" she asks. "I went to a seminar last year where we were told that many hospitals have received fines because of all the nursing home transfers. I feel that I am caught in the middle. Does anyone have this clarified in writing? Is a nursing home in fact considered a person’s primary residence? Does that meet the Health Care Financing Administration [HCFA] definition, in which case a liability investigation does not apply?"
Either way, she needs something in writing. "If a HCFA auditor comes in and says, There should have been an investigation,’ or This should have been billed to the liability carrier,’" she needs something concrete to back up her decision. She also needs something to show the nursing home officials to obtain their cooperation.
[If you have feedback on this issue, call editor Lila Moore at (520) 299-8730 or e-mail her at lilamoore@ mindspring.com. Liz Kehrer may be reached at (815) 344-5000. E-mail: [email protected].]
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