July 23, 2014 at 2:10 p.m.
Medicare rules reviewed
Jay County Hospital Board
The Jay County Hospital Board reviewed guidelines on Medicare and nursing homes Wednesday night, since the federal government is cracking down on its rules for reimbursement.
Nursing director Lisa Craiger gave a presentation about requirements that need to be met in order for Medicare to cover costs for patients who are sent to a skilled nursing care facility.
"The public (has a) misconception that Medicare will pay for all this," Craiger said.
She explained that according to the rules, Medicare Part A, which covers inpatient stays in hospitals, does not cover nursing home stays without meeting inpatient qualifications. Even then, it may not cover all of the nursing home costs.
"Medicare A will not cover your stay in a nursing facility without a three-day qualifying stay (in a hospital)," she said.
Hospital stays must meet two criteria of severity and medical necessity justifying that the care can only be received under the care of a doctor in a hospital. A patient must accumulate at least three days - each day is counted at midnight - of meeting both criteria to qualify for the nursing home coverage.
If a patient is being treated for a condition during the first two days and spends the third day in observation, the criteria are not met and Medicare could refuse to pay for nursing home service.
Even if the patient does meet the qualifications, Medicare will pay 100 percent of the nursing home costs up to 20 days, then it pays all but $137.50 from days 21-100.
But even then, there is a catch. Once the patient no longer meets necessity requirements for rehabilitation care or other complex nursing care - for example, a patient meets rehab goals after a knee surgery - Medicare can refuse to pay for any additional costs accumulated at that nursing home.
Craiger explained to the board that if Medicare audits cases and determines that the hospital stay did not meet the three-day requirement, it could refuse to pay for any nursing home stay, which puts the entire financial burden on the patient or patient's family.
"They are really scrutinizing everything we do," Craiger said.
Hospital chief of staff Dr. Mark Haggenjos said when legislators talk about healthcare savings in Medicare by reducing "fraud and abuse," this issue falls into that category.
"That shows up a savings for fraud and abuse," he said of Medicare working to enforce its own rules. "That's one of the things they're doing to save money."
Haggenjos said doctors must give the necessary care to their patients, but sometimes have to be the "bad guys" and inform those patients that their medical costs might not be completely covered by Medicare.
Medicare auditors make a percentage off of any money they discover should be disallowed, giving a strong incentive to uncover non-qualifying charges, said chief financial officer Don Michael. If unqualified charges are found even after they are paid, Medicare can demand the hospital or other facility repay the money to the government.
"It's a vicious cycle, it really is," said board member John Nill.
Haggenjos told the board that there are options available for people who may need to pay for nursing home care but don't meet Medicare's qualifications and that the extra work to take those avenues are up to the patient or family.
In other business Wednesday, the hospital board:
•Heard a report from auxiliary president Marilyn Post. During January, 68 volunteers put in 969.75 hours of work, which Post said was "good" despite the weather.
Post also informed the board that the auxiliary's Easter bazaar and bake sale will take place March 12.
•Heard the financial report from Michael. During January, hospital volumes in all departments except lab were all under budgeted figures. The hospital experienced an operating loss of $798,578 and a net loss of about $760,000.
The hospital has a fiscal year-to-date loss of about $150,000.
•Approved an agreement with Pro-Service Healthcare Management to provide billing services for Dr. Frank Vormohr and Dr. Jerry Whetzel for an initial setup fee of $8,750 and monthly costs of $4,000.
The doctors, who recently contracted to practice as part of Jay County Hospital, were left without a billing service after choosing to join the hospital.
•Approved renewal of membership in the Indiana Hospital Association at a cost of $13,310.
•Approved a Medicare Advantage Plan provided by Universal American. The plan offers lower costs to carriers than typical Medicare coverage.
•Approved payment of 982 checks and disbursements totaling $1,584,507.89.
•Approved a 3-year service agreement with Ortho for a chemistry analyzer machine at a cost of $24,300. That price was a 10 percent discount off the previous contract amount.
•Approved a one-year service agreement for a Sterrad sterilizer machine at a cost of $11,598.
•Approved purchase of a Vitek 2 microbiology analyzer from Biomerieux at a cost of $53,267. The new machine will replace a model that can no longer be repaired.
•Approved a renovation of the Certified Registered Nurse Anesthetist apartment in the Medical Office Building at a cost not to exceed $16,370. The apartment is used to house a visiting CRNA who provides services to the hospital.
Hospital CEO Joe Johnston said the apartment was cobbled together when the need first arose and that the renovation to improve the living arrangements are cheaper than hotel rates.
•Approved a contract with CenturyLink to install a point-to-point T1 line between Jay County Hospital and the Jay Medical Facilities building (formerly known as the Vormohr Medical Center) at a cost of $15,840.
•Approved two amendments to the hospital's pension plans to bring them into compliance with federal legislation.
•Approved a change in the Employee Gainsharing Program to exclude physician wages from the compensation calculation. Doctors are not eligible to be included in the program as mandated by federal law.
•Approved 15 appointments and reappointments to the hospital's active and courtesy staffs.
•Approved adding Wes Schemenaur to the Jay County Hospital Foundation board.
•Approved contracts with three nurse practicioners working in Haggenjos' office. Those contracts were overlooked when Haggenjos' contract to work for the hospital was originally approved.
•Were informed by Johnston that Vormohr and Whetzel's practice will be renamed Jay Family Medicine, effective March 1.[[In-content Ad]]
Nursing director Lisa Craiger gave a presentation about requirements that need to be met in order for Medicare to cover costs for patients who are sent to a skilled nursing care facility.
"The public (has a) misconception that Medicare will pay for all this," Craiger said.
She explained that according to the rules, Medicare Part A, which covers inpatient stays in hospitals, does not cover nursing home stays without meeting inpatient qualifications. Even then, it may not cover all of the nursing home costs.
"Medicare A will not cover your stay in a nursing facility without a three-day qualifying stay (in a hospital)," she said.
Hospital stays must meet two criteria of severity and medical necessity justifying that the care can only be received under the care of a doctor in a hospital. A patient must accumulate at least three days - each day is counted at midnight - of meeting both criteria to qualify for the nursing home coverage.
If a patient is being treated for a condition during the first two days and spends the third day in observation, the criteria are not met and Medicare could refuse to pay for nursing home service.
Even if the patient does meet the qualifications, Medicare will pay 100 percent of the nursing home costs up to 20 days, then it pays all but $137.50 from days 21-100.
But even then, there is a catch. Once the patient no longer meets necessity requirements for rehabilitation care or other complex nursing care - for example, a patient meets rehab goals after a knee surgery - Medicare can refuse to pay for any additional costs accumulated at that nursing home.
Craiger explained to the board that if Medicare audits cases and determines that the hospital stay did not meet the three-day requirement, it could refuse to pay for any nursing home stay, which puts the entire financial burden on the patient or patient's family.
"They are really scrutinizing everything we do," Craiger said.
Hospital chief of staff Dr. Mark Haggenjos said when legislators talk about healthcare savings in Medicare by reducing "fraud and abuse," this issue falls into that category.
"That shows up a savings for fraud and abuse," he said of Medicare working to enforce its own rules. "That's one of the things they're doing to save money."
Haggenjos said doctors must give the necessary care to their patients, but sometimes have to be the "bad guys" and inform those patients that their medical costs might not be completely covered by Medicare.
Medicare auditors make a percentage off of any money they discover should be disallowed, giving a strong incentive to uncover non-qualifying charges, said chief financial officer Don Michael. If unqualified charges are found even after they are paid, Medicare can demand the hospital or other facility repay the money to the government.
"It's a vicious cycle, it really is," said board member John Nill.
Haggenjos told the board that there are options available for people who may need to pay for nursing home care but don't meet Medicare's qualifications and that the extra work to take those avenues are up to the patient or family.
In other business Wednesday, the hospital board:
•Heard a report from auxiliary president Marilyn Post. During January, 68 volunteers put in 969.75 hours of work, which Post said was "good" despite the weather.
Post also informed the board that the auxiliary's Easter bazaar and bake sale will take place March 12.
•Heard the financial report from Michael. During January, hospital volumes in all departments except lab were all under budgeted figures. The hospital experienced an operating loss of $798,578 and a net loss of about $760,000.
The hospital has a fiscal year-to-date loss of about $150,000.
•Approved an agreement with Pro-Service Healthcare Management to provide billing services for Dr. Frank Vormohr and Dr. Jerry Whetzel for an initial setup fee of $8,750 and monthly costs of $4,000.
The doctors, who recently contracted to practice as part of Jay County Hospital, were left without a billing service after choosing to join the hospital.
•Approved renewal of membership in the Indiana Hospital Association at a cost of $13,310.
•Approved a Medicare Advantage Plan provided by Universal American. The plan offers lower costs to carriers than typical Medicare coverage.
•Approved payment of 982 checks and disbursements totaling $1,584,507.89.
•Approved a 3-year service agreement with Ortho for a chemistry analyzer machine at a cost of $24,300. That price was a 10 percent discount off the previous contract amount.
•Approved a one-year service agreement for a Sterrad sterilizer machine at a cost of $11,598.
•Approved purchase of a Vitek 2 microbiology analyzer from Biomerieux at a cost of $53,267. The new machine will replace a model that can no longer be repaired.
•Approved a renovation of the Certified Registered Nurse Anesthetist apartment in the Medical Office Building at a cost not to exceed $16,370. The apartment is used to house a visiting CRNA who provides services to the hospital.
Hospital CEO Joe Johnston said the apartment was cobbled together when the need first arose and that the renovation to improve the living arrangements are cheaper than hotel rates.
•Approved a contract with CenturyLink to install a point-to-point T1 line between Jay County Hospital and the Jay Medical Facilities building (formerly known as the Vormohr Medical Center) at a cost of $15,840.
•Approved two amendments to the hospital's pension plans to bring them into compliance with federal legislation.
•Approved a change in the Employee Gainsharing Program to exclude physician wages from the compensation calculation. Doctors are not eligible to be included in the program as mandated by federal law.
•Approved 15 appointments and reappointments to the hospital's active and courtesy staffs.
•Approved adding Wes Schemenaur to the Jay County Hospital Foundation board.
•Approved contracts with three nurse practicioners working in Haggenjos' office. Those contracts were overlooked when Haggenjos' contract to work for the hospital was originally approved.
•Were informed by Johnston that Vormohr and Whetzel's practice will be renamed Jay Family Medicine, effective March 1.[[In-content Ad]]
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