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

[Guest guest]

thank you!

1 Do mean the same extended visit time code we use in t he office?

2 I have often wondered what to do when i have to rush over there .In the

office there is a code for the emergency type event but in the NH or SNF

I have only upcoded if it was legit Could you comment?

Thanks for the info about the r ate hikes i think I will say YES

everytime they ask til JULY 1 no matter what.

3 It is actually fairly rewarding work The staff at Nh sometiems turns over

a lot but often they are working there because they like the work and that

makes for a sweet environment that they just enjoy these patients

The SNF patients often get to go home & that is way nice!

I had a guy who went from home, declinig horribley, to a hospice house to

the nh and now no one expected he is home agian with is elderly wife he

gets up from his chair in incredible slow motion but he gets up!

The trouble indeed is often the regulations, the faxes ,the calls But the

emr as points out makes a hug difference- they fax to me i see it on

t he lap top, i answer and sign it and sen it back in 30 sec.

And yes I have the creatinine med list etc in the chart in front of me

even o nthe weekend.

The detail for me is that I only go to one facility and I can walk there in

3 min.Unless there is snow( it is a littel non-path over the stream and

through the woods so in winter I had to drive augh .25 mile around the

corner ) But that makes the nurses like me becasue i am so availabe when

something happens.

Makes a case for consolidation of medical facilities for efficiency Docs do

not want to drive to hospitla A and hospital B and the offcie and Facility X

and NH Y

One of the biggest problems i face is the communication

People come out of MAine medical center in Portland having being transfered

there from lin Memorial in farmingotn but having been cared for by a

PCP in Strong MAine and to know the REAL med list The r eal dx list

allergies etc is a nightmare.

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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