Medicare pays nursing homes to provide skilled services (therapy, wound care, etc) to patients, and trusts nursing homes to accurately report each patient's healthcare status.  The only time that Medicare audits a patient's chart is when a problem has been identified.  With over 16,000 nursing homes and thousands of assisted livings and group care homes in the US, many things are overlooked when it comes to auditing patient care.  But there are many ways th
     The more complicated a patient's needs, the higher the amount that Medicare will pay a nursing home.  Nursing homes are able to increase their billings by listing every possible diagnosis for the patient.  For example, if a doctor lists "Confusion possibly due to Alzheimer's Dementia" on the hospital History & Physical, a nursing home can list 1) Alzheimer's Disease, 2) Dementia, and 3) Altered Level of Consciousness.  Since they are only able to bill for conditions for which the patient is being actively treated, nursing homes can ask their physician to order low doses of medications commonly used to treat those diagnoses.  The physicians are usually willing to do so, and are able to increase their billed amounts accordingly.  They'll tell the patients/families that they're concerned about the patient, but it can be very difficult for patients to have all of their medications changed in order for the nursing home to increase its revenue.
     Those medications have certain side effects, which can mean additional diagnoses of agitation and difficulty sleeping.  The patient will also require speech therapy, physical therapy, and occupational therapy.  If the reason that the patient was sent to the hospital in the first place was a fall, there are additional potential diagnoses of pain management, constipation (due to the pain medications), dizziness ... and of course, the patient's usual home medications (such as high blood pressure, etc). 
     It's possible for a patient with virtually nothing wrong with him when he left home to return with 15-20 new diagnoses.  When he arrives at home, his primary doctor can discontinue all of the new medications - the patient might go through hell with all of the changes to his system, but the nursing home would have been able to bill at the maximum rates that Medicare will pay.  For more information about how nursing homes operate, order The Nursing Home Survival Guide on this site.  
     Have a nice week!  More next weekend!
 


Comments

10/19/2013 2:07am

Unique site!!! Great content, Thanks for it..

Reply
RN
01/03/2014 10:15pm

We have to list a diagnosis for every pill taken whether it is over-the-counter or prescribed. There has to be a diagnosis for every therapy. Speech may treat for dysphagia or cognitive therapy and PT for aftercare of a fracture or CVA and OT for feeding. Yes, even constipation has to be listed if the resident is on a stool softener. Talk to your government, not the administration. It's the law.

Reply
l.e.green
01/15/2014 8:35pm

I realize that each medication and therapy requires a diagnosis; however, nursing homes are able to "pad" the diagnoses in order to maximize profits. "Alzheimer's Dementia" morphing into several different diagnoses is a perfect example of this practice. This happens at the administrative level, before the chart ever hits the medical floor.

Diagnoses are able to be used only if the patient is currently receiving treatment for them - so medications or treatments can be prescribed in order to increase revenue. This isn't a legislative issue, this is a method that nursing homes use to increase their revenue. At a time when more oversight is needed, systemic cutbacks have made it harder to catch even the most blatant of fraud.

Reply
04/12/2014 1:07am

Thanks for sharing the information. Really it is very descriptive which helps to understand the real fact of medicare billing. It is true that the nursing home bill is so high that many people could not afford this. I am very benefitted for this information and I am waiting for next valuable information.

Reply
08/14/2015 2:33pm

Check out the most reliable essay service in the market! Students choose us, because we care about our customers. Visit us now!

Reply

Diagnoses as having MS in 2003 and I am doing incredibly well, and when you have MS "extremely well" indicates being able to cause a regular or near regular lifestyle, but it does not necessary mean strike 100 % free.

Reply
01/10/2016 11:00pm

Very informative post about medicare)

Reply

I discovered a desirable knowledge on your blog. I also recommend this blog with my friends

Reply
04/26/2016 1:45am

Hi nice information thank for sharing with us keep it up i get here nice information.

Reply
06/27/2016 9:01am

LDL cholesterol once in a while is called """"terrible"""" cholesterol. A high LDL level prompts a development of cholesterol in your veins. (Courses are veins that convey blood from your heart to your body.)

HDL cholesterol once in a while is called """"great"""" cholesterol. This is on the grounds that it conveys cholesterol from different parts of your body back to your liver. Your liver expels the cholesterol from your body. Want to be more assured? Just eye wash our services in bergmanclinics.nl

Reply

Very informative post. Thanks for sharing such important information. This will be center of attraction for many.

Reply

Nice Site really Your work is really great and too useful. I enjoyed visiting your site. You have done a truly excellent Job.

Reply
09/17/2016 2:47am

There will come a time when the worst thing you expect to happen, will happen. It is best to be prepared for natural calamities or sudden emergencies.

Reply
09/26/2016 5:28am

Hey, great blog, but I don’t understand how to add your site in my rss reader. Can you Help me please?

Reply
11/02/2016 5:09am

Roofing is a crucial component in a house. Here are some things every homeowner should know.

Reply
11/08/2016 12:36am

They'll tell the patients/families that they're worried about the patient, yet it can be exceptionally troublesome for patients to have the majority of their meds changed all together for the nursing home to expand its income.

Reply
11/12/2016 2:46am

The Los Angeles housing market is hitting record levels of craziness with ever-rising housing - and rental - prices discouraging people from buying. The number of sales stays flat as prices rise. This doesn't mean that agents have a rough time and are doomed to poverty. 

Reply
12/14/2016 4:08am

Very inspirational to hear about someone pursuing their dream and becoming successful instead of following the traditional path.

Reply
12/14/2016 10:54pm

After school programs are a great source of positive activities

Reply

Really a very fine way to express and looking a very pleasant article with full of healthy information. I am definitely going to tell in my class about this platform and the information shared here. Very well written.

Reply
05/02/2017 5:13am

Been reading this site for awhile now, always has really good posts and topics please keep it up! loads of blogs are going under lately from lack of new posts etc!

Reply

Reply



Leave a Reply