getting paid for nursing home patients?

[beebermd]

hello all,

I'm looking for some advice. I have a friend who has a billing company that kinda specializes in nursing home care. We partnered up and I have taken on quite a few patients in about 4 or 5 homes. We have been going on for about a month. My only hang up, is that I am not familiar with the logistics in this space. billing aside, How are docs usually compensated in these scenarios? The staff is usually calling me and I have to do all these orders and mindless paperwork, but I have no compensation (or contract for that matter) from the nursing homes themselves. One or two may be willing to give me a stipend, but the others are pushing back. They already have medical directors, but they have nothing to do with my patients, so am I considered a director as well? if so, should I be getting a stipend? One place wants to give me a 6 month trial, and then they will see if they want to give me a stipend. Soooo........they want me to work for free for 6 mths? Im thinking this cant be normal. They keep giving me the run around and I feel like I may be getting taken advantage of. I feel like they will continue this unless I give them some kind of ulitimatum. but wanna make sure im being reasonable. I just dont know how this is supposed to work. Its a new world for me. Any insight would be helpful.

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[5150man]

hello all,

I'm looking for some advice. I have a friend who has a billing company that kinda specializes in nursing home care. We partnered up and I have taken on quite a few patients in about 4 or 5 homes. We have been going on for about a month. My only hang up, is that I am not familiar with the logistics in this space. billing aside, How are docs usually compensated in these scenarios? The staff is usually calling me and I have to do all these orders and mindless paperwork, but I have no compensation (or contract for that matter) from the nursing homes themselves. One or two may be willing to give me a stipend, but the others are pushing back. They already have medical directors, but they have nothing to do with my patients, so am I considered a director as well? if so, should I be getting a stipend? One place wants to give me a 6 month trial, and then they will see if they want to give me a stipend. Soooo........they want me to work for free for 6 mths? Im thinking this cant be normal. They keep giving me the run around and I feel like I may be getting taken advantage of. I feel like they will continue this unless I give them some kind of ulitimatum. but wanna make sure im being reasonable. I just dont know how this is supposed to work. Its a new world for me. Any insight would be helpful.

It took me about 2 years out to realize there is a lot of paperwork for the nursing home that doesn’t help the patient. Which is why I no longer follow patients in the nursing home. Let the medical director who gets a stipend deal with their lame paperwork.
I don’t see any way for you to get paid to do it short of being their medical director.

 

[Keona]

hello all,

I'm looking for some advice. I have a friend who has a billing company that kinda specializes in nursing home care. We partnered up and I have taken on quite a few patients in about 4 or 5 homes. We have been going on for about a month. My only hang up, is that I am not familiar with the logistics in this space. billing aside, How are docs usually compensated in these scenarios? The staff is usually calling me and I have to do all these orders and mindless paperwork, but I have no compensation (or contract for that matter) from the nursing homes themselves. One or two may be willing to give me a stipend, but the others are pushing back. They already have medical directors, but they have nothing to do with my patients, so am I considered a director as well? if so, should I be getting a stipend? One place wants to give me a 6 month trial, and then they will see if they want to give me a stipend. Soooo........they want me to work for free for 6 mths? Im thinking this cant be normal. They keep giving me the run around and I feel like I may be getting taken advantage of. I feel like they will continue this unless I give them some kind of ulitimatum. but wanna make sure im being reasonable. I just dont know how this is supposed to work. Its a new world for me. Any insight would be helpful.

We bill it as a visit when we see the patients. I don’t get paid if I don’t go see them. They have to all be seen every 60 days. Or within 14 days of new admissions. I have a day a week that I am “off” but where I see the ones who need seen. They usually get admitted in waves. I’ll usually have multiple break their hips all at once and then they slowly get discharged, then repeats a few months later. I only see patients from our own office and alternate with one of the other mds for the people in our office who don’t go to the nursing home. They try to bundle all the orders that need signed so I can sign them when I get there each week. I don’t fill out hardly any paperwork but yesterday I signed an inch thick of papers before I left the office. Mind numbing.

 

[sloh]

It took me about 2 years out to realize there is a lot of paperwork for the nursing home that doesn’t help the patient. Which is why I no longer follow patients in the nursing home. Let the medical director who gets a stipend deal with their lame paperwork.
I don’t see any way for you to get paid to do it short of being their medical director.

Is it even worth the money being a medical director?

 

[5150man]

 

[SuckySurgeon7]

My friend works at a SNF as a consultant. He sees patients a couple times a week and bills for each visit with each patient as a separate outpatient encounter. My questions:
-For those docs who do this as primary, why not see each patient multiple times weekly? You would be more familiar with each patient, less interval changes, so you could copy-forward notes without having as much to review.
-What codes do you use to bill for your visits for SNF patients at present?

My friend probably makes 250k or more by seeing the same patients multiple times weekly and everyone involved seems to like this approach as opposed to the once-a-month approach. Obviously, there's a need out there for docs to see each patient, but spreading ourselves too thin also seems more difficult. Just wanted to hear what y'all's thoughts are.

 

[sloh]

My friend works at a SNF as a consultant. He sees patients a couple times a week and bills for each visit with each patient as a separate outpatient encounter. My questions:
-For those docs who do this as primary, why not see each patient multiple times weekly? You would be more familiar with each patient, less interval changes, so you could copy-forward notes without having as much to review.
-What codes do you use to bill for your visits for SNF patients at present?

My friend probably makes 250k or more by seeing the same patients multiple times weekly and everyone involved seems to like this approach as opposed to the once-a-month approach. Obviously, there's a need out there for docs to see each patient, but spreading ourselves too thin also seems more difficult. Just wanted to hear what y'all's thoughts are.

I do SNF and gross upper 6 figures minimum as consultant. I don't think primaries can see patients more than every 30-60 days otherwise they get flagged by CMS.

 

[SuckySurgeon7]

I do SNF and gross upper 6 figures minimum as consultant. I don't think primaries can see patients more than every 30-60 days otherwise they get flagged by CMS.

Thanks, I only do inpatient, so I don't know the limitations.

 

[SuckySurgeon7]

I do SNF and gross upper 6 figures minimum as consultant. I don't think primaries can see patients more than every 30-60 days otherwise they get flagged by CMS.

Okay, so my friend told me that he knows primaries who are seeing their patients multiple times weekly and thinks that the 30-60 day thing is more likely a minimum requirement rather than an upper limit. Anyone who is primary who can comment on this?

 

[Ironheme]

A lot of coding/billing is based on medical necessity... So if it's not medically necessary to see a patient, then it's not appropriate to bill. Just because someone you know is billing nursing home patients multiple times per week does not mean it is right (or wrong). I also think it's good practice to think - is what I'm doing medically necessary - helps prevent fraud.

Older source: "Medical necessity is the “overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted.” Source: A Refresher on Medical Necessity

Regarding the 60 days - yes, there's the 30/60/90 day nursing home rule. AFP has a couple of good articles on this. Established NH patients that have been there for at least 90 days, minimum time to see them is every 60 days. It's not uncommon for docs to see NH patients every 30 days (what I typically do). But multiple times per week in a NH? I don't even see my normal clinic patients that often unless it's an infected wound or something similar.

 

[Keona]

My friend works at a SNF as a consultant. He sees patients a couple times a week and bills for each visit with each patient as a separate outpatient encounter. My questions:
-For those docs who do this as primary, why not see each patient multiple times weekly? You would be more familiar with each patient, less interval changes, so you could copy-forward notes without having as much to review.
-What codes do you use to bill for your visits for SNF patients at present?

My friend probably makes 250k or more by seeing the same patients multiple times weekly and everyone involved seems to like this approach as opposed to the once-a-month approach. Obviously, there's a need out there for docs to see each patient, but spreading ourselves too thin also seems more difficult. Just wanted to hear what y'all's thoughts are.

In a snf some of those patients are going to have a lot more acute issues than my long term nursing home patient who lives there with stable dementia. My stable dementia patients I see every 30-60 days. My snf patients I sometimes see once a week (rarer) and usually more when they’re first admitted but typically every 30 days.