MDS Alert

Published on Sun Jan 01, 2006 PDF

Question: Should your facility do preadmission screening to determine whether to accept a resident whose costs of care will greatly exceed the PPS rate?

Answer: The facility staff should have a clear grasp of a resident's diagnoses and projected course of treatment generally, so they understand what  may or may not be required in the near future, says Janet Feldkamp, RN, BSN, LNHA, JD, with Benesch Friedlander Coplan & Aronoff LLP in Columbus, OH. Otherwise, you can end up with unexpected bills for expensive, non-excluded treatments under Part A's inclusive rate, she cautions.

But facilities generally shouldn't refuse to take a Medicare patient for financial reasons, says attorney Ari Markenson with Epstein Becker & Green PC in New York City. "If you do that on an individual case basis, you're definitely asking for trouble with the Centers for Medicare & Medicaid Services and the state," he says. A facility can make a decision not to accept residents with particular clinical conditions who require services beyond the facility's capability, such as the ability to provide IV therapy, blood transfusions or ventilator care, as an example, says Markenson. But the restriction on admitting patients requiring those services must apply to all payer types, he emphasizes.