We
received a bill for a 72 hour hold. The client had Medicare coverage and
the facility received a payment. The facility now wants us to pay the
deductible and co insurance. One of our supervisors said if they have a
contract with Medicare they have to accept that payment in full. I had
asked the woman from the facility if they were suppose to accept that in full
like the prepaid health plans and MA and she said no it’s different. What
do other counties do? Our policy has been we are the payor of last
resort. If the client had Medicare we would not pay anymore and if they
were not on MA at the time we would only pay what MA would have paid.
Thank
you
Bobbi
Sivonen
Fiscal
Supervisor
Koochiching
County Public Health and Human Services
9 comments:
We pay the Medicare deductible. I do not know the reason why though.
We just had one that the patient only had Medicare Part A. We paid only the remaining balances for the hospital and professional charges for the 72 hours... Nothing more. I think that we pay the deductible and copays because the county has to pay for it in full if they do not have insurance... this actually saves us a few bucks. Keep in mind, I only have 2.5 years under my belt and have only paid 2 72 hour holds in that time!
Jen @ Grant
If the client has MA, we pay the deductible or co-pay. If they do not have insurance, we pay $1,135.06 per day for room and board. All other services we pay at the MA rates only.
Caleb
Itasca County
Per social service supervisor...I don’t know that we have had a straight Medicare situation come up in Watonwan County, but it is our policy not to pay co-pays or deductibles. I would most likely say no to paying it.
Kim
Watonwan County
Good Morning,
I'd love to get some more feedback on this. Rice County gets many requests to pay these bills. We don't pay co pays or deductibles for any client. I don't know that the county has to pay any of this. The only statute I can find is 253B.045 which is specific to holds in a regional treatment facility. Our policy however does allow for payment of uninsured residents at the medical assistance rate. (Reasonable and customary). We do have general guidelines for admission and required contact by the provider or we can deny payment.
Our policy needs updating....Lisa Rice County
We have Hold Order Contracts with both Prairie St. John and Sanford Medical Center both located in Fargo, ND. Our contract states:
“The Contractor further certifies that rates of payment do not reflect any administrative or program costs assignable to private pay or third-party pay service recipients. It is understood that the Contractor will bill any available third-party payors for Hold Order/Psychiatric Inpatient Hospitalization Services prior to billing the Agency, including Public Pay Managed Health Care Programs, Medicare, and other private insurance. The Contractor agrees to accept third party allowance as payment in full”.
Also, look at Statute 253B.045 Sub. 2. We have interpreted this to only apply only to Regional Treatment center costs where the state can bill the counties the co-pays and deductibles.
I had our County Attorney look at the 72 hour hold statute because I heard other Counties were saying they did not have to pay them because the hospitals are not regional treatment centers but unfortunately he did not agree.
253B.045 Subd 2- says that Counties will contract with a facility which we do not have right now.
The other issue I have ran into is that the facility says we have to follow the host county contract. I'm not sure how that works when we have our own policy.
Thank you everyone for your responses.
I did ask our County Attorney and he said that we do need to follow the host county contact if there is one.
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