Wiki Inpatient Hospitalist

[LStana]

Hello. How would you handle a situation where the hospitalist discharges a patient to long term care, but there is no bed available, therefore the patient cannot leave? The hospitalist will continue to see that patient and document, but the condition has not changed. Would it be appropriate to bill after the discharge, and if so, would we bill subsequent visits? I am trying to find something in writing, but have been unsuccessful. Please advise. Thank you.

 

[Pam Warren]

If the patient has been discharged from hospital care, and is just hanging out because there is no room at the SNF, then you would not be able to bill for any pro-fee services. All charges must meet medical necessity, so if the patient is cleared for discharge, there is no need to provide medical care as reported by a professional claim. Basically, it's a social visit. If there is an illness that continues after discharge for which there is some medical necessity that requires a physician's intervention, then you do have medical necessity, but otherwise since the patient is basically living on your 'couch', there's no need for physician care.

The whole medical necessity concept is all the rationale you would need to support not billing these services. Unfortunately, this happens a lot, and our providers are mandated to round on the patient every 3 days while they wait for a SNF bed, but the visits are non-billable.