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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:Facility billing
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Post Facility billing
Author: wplauth
Date: Jun 27, 2008 3:30 pm
We are in the process of building a 12-bed palliative care free-standing residential center. We plan to contract with the local hospital and hospice programs. However, is there a way to bill Medicare or third-party payers for a patient's stay, perhaps like long-term acute care facilities, skilled nursing facilities do. I am only familiar with physician billing.
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Re:Facility billing (by SharolHerr on 06/30/2008)
To establish a new facility you will want to be talking with your attorney, contracting and finance folks to explore reimbursement for the stay. To bill medicare for a stay at a facility there would need to be medicare certification established. Using the facility in conjunction with hospice and with the hospital would probably be two very different revenue streams--depending on the contract. Long term care stays are a third medicare or third party payor billing avenue. Acute palliative care in the hospitals is provided by a consult service and the stay is covered by the usual hospital insurance or medicare/medicaid third party payor. i.e. 78 year old with medicare in hospital, the DRG system of reimbursement covers the stay and the physician provider bills through medicare part B. If you did not pursue medicare certification the physician could bill Part B for home visits but there would not be any reimbursement for the stay. Hope this is helpful. Best wishes as you continue to explore this option. Sharol Herr, RN, MSEd, CHPN; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.

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