Nursing home visit billing

[CutsWithFury]

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I have secured a contract to cover podiatry care for two nursing homes close the hospital that I work at. How is billing different for nursing home care encounters compared treating the patient in regular clinic? Is there a difference if I document everything that I typically document for a clinic podiatry note?

And before you ask me why I am bothering with nursing home care I will answer your question...all proceeds are going to my beer fund and cryptocurrency investments.

 

[G0dFather]

If those nursing homes are fully yours to bill and keep then Welcome to the holy grail ... just remember what im about to tell you ... "everytime you hear the clipper, what your really hearing is dolla signs!"

 

[CutsWithFury]

If those nursing homes are fully yours to bill and keep then Welcome to the holy grail ... just remember what im about to tell you ... "everytime you hear the clipper, what your really hearing is dolla signs!"

Their mine alright.

Is it wrong if I inject stemcells into everyone like @lapodiatrist on Instagram?

 

[G0dFather]

Their mine alright.

Is it wrong if I inject stemcells into everyone like @lapodiatrist on Instagram?

LOL ... YES... but seriously its great side income .... evaluate them on first first visit to obtain a 99344 ( i believe ) along with RFC codes that they have ... and on the follow ups you would be billing RFC codes if nothing new happened ... if anything you find that is separately identifiable that you need to E & M then you can tag along a 99347 ... thats pretty much it when it comes to billing in a NH .. there is also wound care codes etc ... but this stuff is highly profitable since there is virtually no overhead !!

 

[CutsWithFury]

LOL ... YES... but seriously its great side income .... evaluate them on first first visit to obtain a 99344 ( i believe ) along with RFC codes that they have ... and on the follow ups you would be billing RFC codes if nothing new happened ... if anything you find that is separately identifiable that you need to E & M then you can tag along a 99347 ... thats pretty much it when it comes to billing in a NH .. there is also wound care codes etc ... but this stuff is highly profitable since there is virtually no overhead !!

Great information my friend.

Watch...my hospital won’t like it because they can’t bill a facility fee [emoji102]

 

[dtrack22]

You can bill initial nursing home evaluations (99304-99306) though you’ll want to check criteria for those because you may or may not to hit the requirements of even the lowest complexity visit. Though I would think you could get a 99304, so long as the PE requirements don’t involve too many systems. If not you just bill the highest level subsequent encounter code you hit (99307-99310 I think).

After that it’s billing like you would in clinic in terms of nail and callus codes, modifiers, debridement codes. The place of service changes (31 I think). Is the hospital submitting the claims to the SNF or to the patient’s insurance for you? I would be surprised if they did. Which means you need your own EHR and do your own billing. So you need to understand the difference between Medicare part A and part B. You need to know your medicare # and likely medicaid. You need to find out what commercial plans you are likely already in network with. Do you need to bring your own instruments with you? Is the hospital going to let you use their instruments and autoclave without them getting any portion of the revenue? You might have to get your own autoclave....etc.

 

[Scrantonicity]

Yeah, billing is pretty much the same as mentioned above. However, because the place of service changes, insurance pays a little less per patient. This is because they realize you are not in your office, so no overhead. They don't take into consideration the back pain you are feeling because you have to reach down and remove shoes/socks/braces and put them back on (unless you have an assistant, but then you're paying an assistant). Hopefully the nursing staff is accommodating and will help you get in and out of the facility ASAP each time.

I'm jealous--wish the nursing homes I have to do actually went straight to my own pocket...my back wouldn't hurt as much.

 

[GreenHousePub]

Is it really worth the broken back, hunting down patients, urine smell, getting spit on etc?

 

[CutsWithFury]

Is it really worth the broken back, hunting down patients, urine smell, getting spit on etc?

I do 700-800 RVUs per month. I have a busy practice. This is the start of a new venture that I can bang out Saturday mornings that puts more money in my back pocket. It’s easy and mindless.

 

[Carbon13]

I do 700-800 RVUs per month. I have a busy practice. This is the start of a new venture that I can bang out Saturday mornings that puts more money in my back pocket. It’s easy and mindless.

I agree. This is a good side avenue of income.
I have secured two brand new memory care facilities and am going to bring an assistant with me the first few times (new private practice owner). I was also confused about the EM codes. My self research brought me to one code and my billing company recommended a different....possibly 99304?

I've also been approached by a local hospital for 1/2 day / week wound care.......but that's a different topic.

I continuously read all these PM News feeds on the old guys complaining because the young "Foot & Ankle Surgeons" have forgotten what podiatry is all about and think they are too good for RFC !

(My opinion).....I think they are mad and getting vocal about it because just maybe they are seeing more competition from a younger group that is a little more hungry and willing take on any "Foot & Ankle Surgery" as well as any side gigs that present themselves. I know I am at least.

Anyways.

 

[G0dFather]

its the same handful of people on PM news that are constantly complaining ... its so nauseating, are we the only profession that has these issues ? come on shut up already !

 

[FAS80]

I have secured a contract to cover podiatry care for two nursing homes close the hospital that I work at. How is billing different for nursing home care encounters compared treating the patient in regular clinic? Is there a difference if I document everything that I typically document for a clinic podiatry note?

And before you ask me why I am bothering with nursing home care I will answer your question...all proceeds are going to my beer fund and cryptocurrency investments.

Im curious, but were you required to sign a contract with the nursing homes? Is this usually the case?

 

[ucdgogie]

I currently am working full time in long term care facilities and if i am using an e&m it is usually 99307 or 99308. Majority of the time it is the normal RFC procedure codes without an e&m unless i treat something else. I work for a larger company and so all instruments and necessary items, EHR, billing are handled for me. I also have an assistant to help with taking shoes on/off and stuff (helps with the back). It is stress free and easy work for sure. Good luck!

 

[Redsting]

I do 700-800 RVUs per month. I have a busy practice. This is the start of a new venture that I can bang out Saturday mornings that puts more money in my back pocket. It’s easy and mindless.

How many wRVUs do you average per patient?

 

[pod87]

I know this thread is a little old, but I am starting out as a podiatrist for a company that provides care to nursing homes and LTC facilities. I don’t have much experience when it comes to coding and billing nursing home visits. So being the first podiatrist working for the company, I just want to make sure I do these things correctly. I would greatly appreciate any input in regards to how to code and bill routine SNF visits and just any other general advice for providing care in nursing homes. You can PM me as well. Thank you!

 

[arghus]

You discussed this long ago, but I wanna know your opinion. Where is it better to work, in the hospital or the nursing home? Because I wanna apply to a home care agency, called assistinghands, to work as a nurse. I think it's better for me to gain experience here, but I still want to know your opinion about it.
It seems that it will be easier for me to take care of sick people because I have already dealt with this since my sister is ill, and I always take care of her.
What do you think about it? Let me know, please.

 

[Pronation]

You discussed this long ago, but I wanna know your opinion. Where is it better to work, in the hospital or the nursing home?

Definitely without a doubt it is better to work in the circus.

 

[GreenHousePub]

You discussed this long ago, but I wanna know your opinion. Where is it better to work, in the hospital or the nursing home?

Nursing home hands down. It's a fast paced, exciting environment with a huge growth potential and refreshing independence. They require only dedicated individuals who are willing to work hard for unprecedented pay.

Also I have the contract on 3 nursing homes and would love to extend the opportunity for you to cover them. Only go-getters need apply.

 

[Utvolsdpm]

Nursing home hands down. It's a fast paced, exciting environment with a huge growth potential and refreshing independence. They require only dedicated individuals who are willing to work hard for unprecedented pay.

Also I have the contract on 3 nursing homes and would love to extend the opportunity for you to cover them. Only go-getters need apply.

Also, must be ethical individual with great morals

 

[heybrother]

I've been getting a lot of emails from nursing home podiatry groups.

Good afternoon, Dr. Heybrother! I hope you are doing well today. I came across your profile and just wanted to reach out and introduce myself. My name is Recruiting Shill and I am the Talent Specialist here at Best Dang Nursing Home Nail Clippers Group. BDNHNC specializes in treating residents of long-term care facilities. Are you entertaining any new job opportunities this year? I am actively recruiting on a part time and full time podiatrist position in Besttown, USA that I thought may be of interest. I understand that you may already be working and have a strong surgical background (hahahhahahahahaha), but if you have any interest in making supplemental income, I would be happy to connect with you. Please let me know if you are interested!

Thanks b.

 

[SouthPod7]

Forgive me. I've been working in nursing homes my whole career, as part of practice, and can't say I would describe my work there this way at all. YMMV.

I'm almost positive he was being sarcastic.

 

[FootsCool]

Hello, this is a super old SDN account lol, I've been a podiatrist for about 5 years now. But I'm also starting a nursing gig tomorrow.

Everything here has been super helpful, but I want to be clear on a few things as I've never done this.

I have a patient list of about 40 patients. They've also sent me their coversheets with background dx and whatnot. I'm basically going, clipping nails/busting crusties and billing E/M (99304 - they're all initial encounters).

Do I also charge for the nail/callous debridement itself? Or is it just part of the E/M? Do I need 25 modifier if I am?

Do I need to worry about putting in diagnosis codes for diabetes, PVD etc? Do I just base this off the cover sheet provided? How do you do it?

I understand the above questions are likely super simple, but I just want to be sure! Thanks.

 

[heybrother]

Hello, this is a super old SDN account lol, I've been a podiatrist for about 5 years now. But I'm also starting a nursing gig tomorrow.

Everything here has been super helpful, but I want to be clear on a few things as I've never done this.

I have a patient list of about 40 patients. They've also sent me their coversheets with background dx and whatnot. I'm basically going, clipping nails/busting crusties and billing E/M (99304 - they're all initial encounters).

Do I also charge for the nail/callous debridement itself? Or is it just part of the E/M? Do I need 25 modifier if I am?

Do I need to worry about putting in diagnosis codes for diabetes, PVD etc? Do I just base this off the cover sheet provided? How do you do it?

I understand the above questions are likely super simple, but I just want to be sure! Thanks.

Clarification on Nursing Home Billing | TLD Systems

“In a nursing home, if you are rendering a service where the E/M is a systemic condition and separately identifiable, can you bill the E/M code and the procedure? I believe you cannot. My biller and a webinar speaker both feel that you can. Their thought is that as long as you have different...

www.tldsystems.com

https://www.hmpgloballearningnetwork.com/site/podiatry/blogged/keys-coding-when-you-are-seeing-patients-nursing-facilities

Correcting Billing for E&M-Nursing Home

If I see a new patient, on my floor, in a multi podiatrist nursing home, and then find out he came from another floor, c...

associationdatabase.com

There's a few above links - I have no connection to any of them. I simply typed in "nursing home billing" and they seemed relevant as I read them.. I don't do nursing home work at all, but I've never seen anything to suggest that the rules of billing have changed because of the location. E&M in general always requires management. Nail and callus debridement has well defined rules related to how its paid for. Nails can sometimes be covered under variations of "pain". There are some slightly different variations to the rules related to the ambulatory nature of the patient. Otherwise, both nails and calluses require specific systemic conditions that qualify under your local LCD and appropriate MD/DO management of the systemic depending on whether its an asterisk condition or not. They must also fit the time table.

I'm personally concerned that nursing home care would be rife with fraud because the simple truth is - the only reason you were brought in is to clip nails/calluses - therefore the assumption and your continued service is based on you making the patient fit.

Last of all - a friend of mine worked for a nursing home group and he was certain their local billing outfit was screwing up his billing for months. You need to be able to go back after the fact and review your patients to see who you got paid on and who you didn't.

 

[GreenHousePub]

I'm personally concerned that nursing home care would be rife with fraud because the simple truth is - the only reason you were brought in is to clip nails/calluses - therefore the assumption and your continued service is based on you making the patient fit.

Nursing home care rife with fraud? No, I don't believe that could ever possibly happen.

 

[ExperiencedDPM]

Our practice had 2 doctors dedicated to nursing home care. Just wasn’t and isn’t my preference. I would see an “aide” trimming the patients fingernails and after all the training wasn’t thrilled about cutting toenails like a robot. To me it has always been more than the money.

If you’re treating patients at a nursing home, do it right. Our doctors had a sterile pack for each patient. Not a loose clipper and not a Bard Parker tray. A dedicated sterile pack.

I used to go once in a while for a complicated wound, etc. And I’d see a local DPM there literally going bed to bed with one pair of clippers. He’d clip and toss them in his pocket and go room to room.

Patients deserve more respect and better care than that garbage.

 

[HardRoadPaved]

Nursing home care rife with fraud? No, I don't believe that could ever possibly happen.

11057 billed in all the non ambulatory patients might be a clue.

 

[FootsCool]

Clarification on Nursing Home Billing | TLD Systems

“In a nursing home, if you are rendering a service where the E/M is a systemic condition and separately identifiable, can you bill the E/M code and the procedure? I believe you cannot. My biller and a webinar speaker both feel that you can. Their thought is that as long as you have different...

www.tldsystems.com

https://www.hmpgloballearningnetwork.com/site/podiatry/blogged/keys-coding-when-you-are-seeing-patients-nursing-facilities

Correcting Billing for E&M-Nursing Home

If I see a new patient, on my floor, in a multi podiatrist nursing home, and then find out he came from another floor, c...

associationdatabase.com

There's a few above links - I have no connection to any of them. I simply typed in "nursing home billing" and they seemed relevant as I read them.. I don't do nursing home work at all, but I've never seen anything to suggest that the rules of billing have changed because of the location. E&M in general always requires management. Nail and callus debridement has well defined rules related to how its paid for. Nails can sometimes be covered under variations of "pain". There are some slightly different variations to the rules related to the ambulatory nature of the patient. Otherwise, both nails and calluses require specific systemic conditions that qualify under your local LCD and appropriate MD/DO management of the systemic depending on whether its an asterisk condition or not. They must also fit the time table.

I'm personally concerned that nursing home care would be rife with fraud because the simple truth is - the only reason you were brought in is to clip nails/calluses - therefore the assumption and your continued service is based on you making the patient fit.

Last of all - a friend of mine worked for a nursing home group and he was certain their local billing outfit was screwing up his billing for months. You need to be able to go back after the fact and review your patients to see who you got paid on and who you didn't.

Appreciate the help and links.

Yes basically its just like clinic, except E/M specific to a nursing facility. I am an associate at my practice for the past 2 years and just want some supplemental income. I've been trying to get a nursing home for a couple years but has been very difficult with local competition. Recently I found a company called PediRite. So far I've been pleased with their operation. They sent me all supplies including a rolling table, white coat, ID, etc. They schedule the patients and I go. They pay 40-50% (I dont exactly recall), I know I've heard 30% before.

But well see if this is sustainable for me. Right now just doing Sunday mornings and full clinic during the week.