Re: Re: : Nursing Home vs Office Codes RVU's --> better pay seeing them in the nursing home?

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I believe a 99354, which is an extended visit in the nursing home, may now

get paid, I'm hoping. For a while, they stopped paying this, but continue

to do so for the 99356 equivalent in the hospitalized patient. That;s in

addition to whatever the visit code should bill at, for the extra time

involved.

I would use a high level new 99306 if it's the first time seeing the patient

in a SNF (for the attending doc), or a 99310 for a complex emergent follow

up visit in the nursing home. If more time is needed than would be

standard, as is often the case in an emergency, try the extended visit code,

and make sure to document your time spent. Remember, time spent includes

any faxes, phone calls, coordination of care, phone calls to family, and

completing the chart documentation since your last visit to see the patient.

This is a different rule than in the outpatient setting.

By the way, I routinely set limits with the nursing home staff about calls,

faxes, and " emergencies " . I tell them, nicely, when they have stepped over

the line. Everyone needs to understand limits, set them. Most will be

happy to have good caring doctors in their building.

AMDA is a great resource, this is from July, so there might be newer stuff

since.

www.amda.com/news/releases/2007/News_Release_%202007_NH_RVUs_07032007.pdf -

Re: : Nursing Home vs Office Codes

> RVU's -->

> better pay seeing them in the nursing home?

>

> I've been working almost exclusively in skilled nursing homes for the

> last 14 years, so let me clarify a few things discussed in the last

> few days:

>

> Most skilled nursing home patients BEDS are paid for by Medicaid, but

> their DOCTORS VISITS are still paid for by Medicare part B. Even

> when a patient is admitted to the skilled section for rehab (Medicare

> part A for rehab or IV services, after a hospitalization) they still

> have their Medicare part B for DOCTORS VISITS. Many physicians avoid

> nursing home patients thinking they only have Medicaid, when their

> Medicare part B does NOT lapse on admission. MOST NURSING HOME

> PATIENTS HAVE MEDICARE FOR US. This should not be regional or state

> specific, if I am wrong and there are states taking nursing home

> patients' medicare part B away when they qualify for medicaid, please

> let me know, that would be terrible. Given that Medicaid is state

> run, but Medicare is ultimately a federal program, I'm not certain

> how that could happen. The exception, of course, would be a patient

> who never qualified for medicare in the first place. That is a

> minority in most nursing homes, given their average population ages.

>

> For 2008, until July 1, when they may change the reimbursements yet

> again, physicians seeing patients in SNF's are getting huge pay

> raises, for some codes up to 23%! Yes, it now pays better to visit

> nursing home patients than in many years, and as well as visiting

> hospital patients. In addition, medicare claims they are re-

> instituting the extended visit codes, which they had dropped for SNF

> work, due to the high complexity and extended time spent on some

> patients. These pay very well, in addition to the regular visit

> codes. Take your time with the patient, document well and get paid

> well.

>

> You must understand the level of care of the facility that you are

> visiting. Absolutely do not bill for office visits in the nursing

> home or nursing home visits if you went to see the patient in an

> assisted living. Also, independent living apartments are often

> associated (built next to) assisted living, those should be billed as

> house calls, which pay very well under Medicare.

>

> Care plan oversight used to be a great payor, but at least here in

> Florida, so many docs abused the privilege, that it is now under

> close scrutiny. The codes still pay, but take the time to document

> carefully.

>

> All of these are great supplements to an office based practice or are

> great low-overhead medicine in and of themselves.

>

> Hope that helps.

> Oh, and Dr. Locke, thanks for the article posted.

>

>

> geriatric rehab doc / subacute SNF specialist

>

>

>> >

>> > Out of curiosity, I looked up the RVU's for office and nursing

> home

>> codes.

>> >

>> > These are from 2006.

>> >

>> > Link to an Xcel file is in the pdf located here...

>> >

>> >

>>

> http://www.acc.

> <http://www.acc.org/advocacy/pdfs/2006RVUsandNationalAverageMedicarePay>

> org/advocacy/pdfs/2006RVUsandNationalAverageMedicarePay

>> ments1

>> > 22305.pdf

>> >

>> > If I'm reading this correctly, does the similar nursing home

> visit

>> (time,

>> > complexity, etc) pay better than the same type of office visit?

>> >

>> > Could someone who is experienced in nursing home visits please

>> explain and

>> > confirm the issues with coding nursing home visits when you see

> the

>> patient

>> > in the nursing home and not in the office?

>> >

>>

>>

>>

>>

>>

>>

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