Nursing homes are as vital as hospitals or other centers of medical care at the present. They are also a vital element in ensuring the well-being and health of those living in contemporary American society. This is especially true for those who are weak and elderly.
There are various kinds of nursing homes, including skilled nursing homes (SNFs), Independent Living Facilities, and Assisted Living Centers. These facilities bill their clients or their legal appointee to provide their service. The State has set up guidelines to guide these charging.
Let’s take a look at what the rules for billing in nursing homes are, and what factors impact the process of billing.
Period of Coverage of Bill
The nursing home typically sends out monthly bills to its residents for the services it has rendered as well as the medical care it has given. The resident (or their legal representative) signs an agreement with their nursing facility. The contract provides details on billing and the frequency of billing.
In general, the bill comprises the cost of all the essential services offered. Sometimes, however, it may also contain charges for other related services.
A billing cycle refers to the period (calculated by an amount of time in per month, for example) during which the billing occurs. The nursing facility can also be charged a prorated amount for the month that the resident was admitted. In the event that the patient did not begin with his admission on the initial date of the cycle the amount of billing is the cost per day of the room or board multiplied by a total number of calendar days. Sometimes, the facilities may also issue pre-bills for the costs for the next month.
Level of Care Provided
Assisted Living Centers such as SNFs and nursing homes provide various levels of care, based on the requirements of their patients. The degree of care provided by these facilities determines the amount they charge the patients they treat to a considerable degree. Furthermore, the levels of care can be divided into primary, secondary, tertiary, as well as Quaternary levels care.
The primary level of medical care is the most basic or fundamental level of medical treatment. Therefore, routine testing of a patient’s vitals is under primary medical care. In addition, if you need specialist doctors to manage your condition the primary care level is responsible for this coordination.
Then there’s the secondary stage of treatment. Medical specialists typically provide this type of service. For instance, a primary care physician could take care of a patient suffering from common stomach indigestion. If the doctor sends them to a gastroenterologist to conduct further examination of their stomach, this becomes the second level of treatment.
Tertiary care can be very expensive that requires sophisticated equipment and a great deal of medical know-how. Examples include complex neurosurgeries and micro-surgeries. Tertiary care, which is more complicated in nature cannot be provided by small, conventional health centers or in nursing homes. The nursing home typically refers its patients to specialist Tertiary Care centers.
In addition, there is a quaternary level of care that is nothing more than an extension of the tertiary level of care. It is a very specific degree. Clinical trials in cancer research are an example.
Type of Insurance Coverage
There are a few Medicare Part A guidelines that apply to SNFs. If the medical requirements of the patient satisfy these criteria, Medicare as an insurance provider will cover up to 20 days ‘ hospitalization in the nursing facility. Some insurance policies provide long-term care in nursing homes.
Leaves of Absence
This can be a factor that will affect the cost of nursing homes. The resident may have for them to go away from the facility for a time. The majority of the time the resident or their representative will sign the waiver of the bed holding to secure their room when they leave.
However, this means that the hospital will continue to charge the patient even if he is not there also. In addition, the patient could lose the bed and pay less, but the inability to find a room is possible in the event that the resident returns.
It is worth noting that the US Government has also specifically designed and published Nursing home billing rules for billing nursing homes. There is additionally CPT codes for nurses that can simplify bill-paying. For more details, click here.