We Are Not Billers.

Sasha

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Generally a patients abiloty to.pay should not enter our minds. But when you are doing a bs discharge and you know that insurance wont cover their txp, dont we as advocates have the duty to inform our patients that they will be responsible for the $500 bill out of pocket?
 
Generally a patients abiloty to.pay should not enter our minds. But when you are doing a bs discharge and you know that insurance wont cover their txp, dont we as advocates have the duty to inform our patients that they will be responsible for the $500 bill out of pocket?

I can and do inform the patients and their family. If I am taking a patient home (very rare for me anymore) that is marked as bed confined but I know my report will conflict with that PCS, I will tell them that they might be receiving the full bill from medicare.
 
We have been told we are not allowed to mention a bill. It just tugs on my heartstrings. I cant call myself an advocate knowing im putting them in debt.
 
We have been told we are not allowed to mention a bill. It just tugs on my heartstrings. I cant call myself an advocate knowing im putting them in debt.

I've been told that too. When I worked IFT in ABQ I ignored that rule on a regular basis. I agree with you on that I can't feel like an advocate when I hide from them the fact that the hospital is helping to try and contribute to medicare fraud.
 
Generally a patients abiloty to.pay should not enter our minds. But when you are doing a bs discharge and you know that insurance wont cover their txp, dont we as advocates have the duty to inform our patients that they will be responsible for the $500 bill out of pocket?

Yes.

As medicine evolves more into "if you can't pay you can't have it" and the costs of medical care keeps dramatically increasing, the only way to be a patient advocate is to be appraised of the costs, do our best to minimize them, and to properly inform them so they can make the best choice for themselves.

It is sad to say, but in today's world. Sometimes it is better for the family if the patient chooses to die at home without care than die after seeking it.
 
The thing is, i cant risk my job by ignoring it and i wont risk my license by commiting fraud.
 
The thing is, i cant risk my job by ignoring it and i wont risk my license by commiting fraud.

As medicare/medicade fraud comes under tighter scrutiny, it will be harder and harder to walk that line.

I know, it sucks.
 
We're told not to talk about billing. However, here are my views:


If they need to go by ambulance, the bill should be the least of their worries. It sucks, but with service comes cost. If they are afraid to be checked out due to a possible bill, I tell them there is no bill for me to check them out.

If it's BS and/or they don't need to go by ambulance, I'd advise them of such and state to what limit I'd actually be doing work while going to the hospital "We can take you, but there's nothing I'll be doing for you and you will probably just end up sitting in the waiting room for a few hours"

If they STILL insist on going by ambulance when there is no need, they brought the bill on themselves.
 
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If they are afraid to be checked out due to a possible bill, I tell them there is no bill for me to check them out.

But there is a bill if you transport them.

That is an easy choice to make for people who don't have to deal with the fall out.

They go back to the station not knowing they just broke up a family or sent one to the streets.

That some kids will go without cloths or a home or food in the vain hope of doing all that could be for family memeber. (who is more often than not older and has considerably expensive health problems)

If a provider chooses not to face that, are they really doing no harm?
 
In all honesty, though, there's no way around it. Either universal healthcare, or bill for service. Since we are currently bill for service, you, as a field provider, can't pick and choose who will have to pay. That's up to the bean counters who can do charitable runs based of circumstance, or write things off. We can't.



Like I said, if they NEED to go by ambulance, the bill should be the least of their worries and should be something that has to be worked on later down the line. If they don't need to go, and are told as much, they chose to get the bill.
 
We have been told that billing is not our area of expertise and we really don't know if medicare or medicaid will pay for a call, but in fairness to the pt and family if I feel certin that telling grandmaw that medicare won't cover ambulance transport for a hang nail is our responsibility, as an advocate for the pt I feel morally responsiblt to tell the family they are about to get a $400.00 ambulance bill plus $12.00 dollars per mile
 
We have been told that billing is not our area of expertise and we really don't know if medicare or medicaid will pay for a call, but in fairness to the pt and family if I feel certin that telling grandmaw that medicare won't cover ambulance transport for a hang nail is our responsibility, as an advocate for the pt I feel morally responsiblt to tell the family they are about to get a $400.00 ambulance bill plus $12.00 dollars per mile

That is modest.

I have seen dead people who got bills for $20,000 worth of attempted resucitation. With a hospital that pursued the estate for it.
 
And until there is universal healthcare in this country (hopefully never) and we tell our patients truthfully and correctly on whether or not they should go by ambulance, this issue is truly moot.


It sucks, but it's a necessary "evil".
 
And until there is universal healthcare in this country (hopefully never) and we tell our patients truthfully and correctly on whether or not they should go by ambulance, this issue is truly moot.


It sucks, but it's a necessary "evil".

Is it so easy to tell people if they cannot afford help they are not going to get it?
 
Generally a patients abiloty to.pay should not enter our minds. But when you are doing a bs discharge and you know that insurance wont cover their txp, dont we as advocates have the duty to inform our patients that they will be responsible for the $500 bill out of pocket?


Forgive me I'm not to familiar with transfers but if a hospital orders transportation that isnt warranted and the patient receives a bill, the hospital should be on the hook for it. They should have known better, it isn't to difficult a concept, if they fit the criteria then they go by ambulance if they don't the hospital makes other arrangements.

Problem solved, once the hospital gets a few bills for transports that weren't warranted they will pay closer attention.
 
Forgive me I'm not to familiar with transfers but if a hospital orders transportation that isnt warranted and the patient receives a bill, the hospital should be on the hook for it. They should have known better, it isn't to difficult a concept, if they fit the criteria then they go by ambulance if they don't the hospital makes other arrangements.

Problem solved, once the hospital gets a few bills for transports that weren't warranted they will pay closer attention.

The hospital might just pay those bills because an empty bed can be filled with a patient who will bring in much more.

Several transport services I am familiar with have contracts where the hospital will pay a portion of the bill if it is not collectable.

But they will first fill out the paper work with the right words to get the highest chances of medicare picking it up.
 
The hospital might just pay those bills because an empty bed can be filled with a patient who will bring in much more.

Several transport services I am familiar with have contracts where the hospital will pay a portion of the bill if it is not collectable.

But they will first fill out the paper work with the right words to get the highest chances of medicare picking it up.

Hahaha...this is exactly what I do. We specifically write out the exact reasons at the end of our narrative detailing why the pt needs stretcher transport as opposed to wheelchair transport, I do my best to justify it, and with about 3 of the hospitals we go to if insurance denies the claim they cough up the dough, since they dispatched it. If they want to call us for patients who don't need ambulance transport, that's their problem (though I am not any less annoyed).
 
Hahaha...this is exactly what I do. We specifically write out the exact reasons at the end of our narrative detailing why the pt needs stretcher transport as opposed to wheelchair transport, I do my best to justify it, and with about 3 of the hospitals we go to if insurance denies the claim they cough up the dough, since they dispatched it. If they want to call us for patients who don't need ambulance transport, that's their problem (though I am not any less annoyed).

I know the game.
 
We are allowed to talk about billing, but we are not allowed to dissuade patients from going to the hospital. We are also not allowed to make promises, so there is a fine line.

On 911 calls where patients need to go by ambulance and are worried about billing we explain that both the ambulance and the hospitals have "charity care", and that you have to apply for it, and that it is possible to arrange payment plans. I will usually let the registration person know that the patient is interested in applying for charity care when we drop of the paperwork because they are the people who arrange it.

If they need to get seen, but not necessarily go in by amb (the people who will end up in triage) we will ask if they have another way to get to the hospital. This especially applies when their husband/wife/sister whomever is standing saying "I'll follow you to the hospital".

On transfers we are allowed to inform the staff and/or family that the run may not be covered. Usually we go over it with the nurses when we go over the paperwork/PCS. On calls where it is blatantly obvious it won't be covered most of the time the RNs will tell the family that before we get there. If they family insists on the ambulance anyway we will go over it with them again, including explaining the mileage charge, and calculating how much it will be. At that point if the family insists, it goes in the run report.

I had one case where two sisters ate a $2500 transport (it was ~150 miles) becuase their mother was so obnoxious neither of them wanted to be stuck in the car with her for the trip.
 
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