Sunday, March 6, 2016

Skilled Nursing Violated Mass Health Rules by Billing for Co-Pays and Days Patient was in Other Facilities and for Holding the Room in Case Patient Wants to Return

On 27 February we reported about Golden Living Skilled Nursing facility billing for Co-Pays and for 'holding the room' for 20 days while patient was in a hospital then in a rehabilitation center as an inpatient. In addition, South East Massachusetts skilled nursing facility also billed the same patient for Co-Pays for other inpatient dates. It's not like they don't know the patient has Medicare and Medicaid (Mass Health). They obviously had this information and didn't deny having it when I called them. After multiple calls to billing centers that indicate the bills to be correct, and repeated mailings of bills, and calls from these skilled nursing facilities, I contacted Medicare and Mass Health and learned these facilities inappropriately billed the patient. The Skilled Nursing billing person said they expect patients to pay their Co-Pay and it's usual for the Skilled Nursing facility to charge for 'holding the room' when the patient has gone off to a hospital with deep vein thrombosis and pulmonary embolism. Really. Mass Health indicates that Skilled Nursing facilities know they are not permitted to bill when the patient is in the hospital, another facility, or to 'hold the room'. They are also not allowed to bill for 'Co-Pay' except for a nominal charge -- something like $3. I really would like to know what compels people at these Skilled Nursing facilities to behave in such a way. I wonder what else they do that they know they are not supposed to do because this one is so obvious and leaves many records. Fortunately, Mass Health intervened and called the Skilled Nursing facilities to 'correct' them on how to follow the 'contract' they have with Mass Health. We are greatly relieved. It is disturbing to learn that large organizations that are under contract with Federal Medicare and State Medicaid Mass Health are willing and actually do bill inappropriately and then fail to correct their errors when patients and their representatives call to investigate. Having bills (as you might have noticed nearly $5,000 in the case of Golden Living, and others from SE Massachusetts) and then checking with the institution sending the bills and having them give inaccurate information, then threatening to attach the patient's Social Security check, is disturbing. Deeply disturbing. I wonder how many other people fall victim to these unscrupulous tactics by skilled nursing facilities billing people.

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