Long-Term Care

Medicare Advantage Q&A with Diane Brown

Billing Alert for Long-Term Care, February 1, 2015

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QWe have chronic problems with delayed discharges from Care Improvement Plus because of their pre-certification system. They require initial PT and OT assessments before they will initiate a precert for acute rehab or NH, and then they have a 48-hour turnaround time for making a decision. We had a patient that was admitted on Mon with acute CVA, needing all three disciplines. We requested acute rehab, they denied acute rehab, and then I had to initiate another precertification for NH, waiting another 48 hours. Also, we had the weekend issue. The patient was discharged on Monday after a seven-day hospital stay. If she had been on regular Medicare, she would have discharged easily on day 3 or 4. This is substandard care for the patient and unfair delayed LOS for the hospital.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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