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Beneficiary Elected Transfers


Most agencies at one time or another admit a patient to the hospital only to find out that the patient has been discharged post hospital to the care of another agency. There are even reports of agencies actively soliciting patients in the home environment and ‘stealing’ them from other agencies. Obviously, there are legal avenues to pursue. Hospitals must notify patients of all agencies in the area who have requested to be put on the hospital’s list of discharging. Actively soliciting patients is unethical and in many cases, against state and federal regulations. Agencies should file complaints with the appropriate regulatory bodies and seek legal counsel but the question is often, “What do we do now?”

And the answer, quite frankly, is nothing.

In order to receive a patient from another agency, three things must occur and be documented. You will find these outlined in the Medicare Benefit Manual – a publication not frequently referenced by agencies who ‘steal’ patients. There are as follows:

  1. The receiving agency must contact the prior agency to let them know of a beneficiary elected transfer.
  2. The receiving agency must inform the patient that the prior agency will no longer be responsible for any care or supplies and will not receive further Medicare payment.
  3. The receiving agency must document that it accessed the RHHI inquiry system to determine if a patient was under the care of another agency.

In the event of a dispute, the RHHI will look for this supporting information. It must be present in order for the receiving agency to be paid. In the event of a dispute, the initial agency must call their RHHI who is responsible for working with both parties.

It is not our job to educate these unethical agencies. Therefore, my suggestion is to do nothing. Do not discharge the patient prematurely and receive a Partial Episode Payment unless you are quite certain that the beneficiary ‘elected’ this transfer. In the case that your patient truly did want to change agencies, it is important to cooperate. In any other case, do not make it easier for the receiving agency to violate patient rights of choice. Do not share this information with the patient thieving agency. An agency that ‘steals’ patients may also be willing to manufacture documentation!

If you have questions, please email us at haydelconsulting@bellsouth.net. As always, we welcome your comments and questions.

2 Comments Post a comment
  1. Derek #

    I find it funny that a consulting agency acts to be of help with biased statements. Keep in mind it is an ethical requirement to give the admitting agency the patient name, mrn, and any other pertinent information needed for the POC. This is called coordination of services. Oh and to state the obvious; if your patient leaves your company its probably because it sucked to begin with. Spend some of that pps money towards checking on your patients status and quit over working your nurses and you’ll probably keep your patients. Or better yet hire these guys for mucho $$$ and get your money recouped.

    Like

    December 13, 2010
    • Derek, thank you for taking the time to express your opinion. I think that there is a misunderstanding on my part regarding your comment.

      In the post I referred to agencies admitting patients who were already seen by other agencies. Obviously the new agency knows the patient name. I am uncertain what you mean by ‘mrn’. I think of that as a Medical record number. Obviously that is not relevant to a receiving agency nor should any medical record number or billing information be given to anyone outside of your agency. I suspect that in your neck of the woods, mrn means something else.

      I did not say that the prior agency should not give information to the receiving agency. I do not advise calling up and volunteering it. It is clearly stated in the Medicare literature that it is the receiving agency’s responsibility to obtain that information. Isn’t that part of the assessment? Finding out the recent history of the patient and gathering all data.

      I wrote that post after visiting a client. The client had a patient who went into the hospital for surgery. The doc wrote orders to discharge to home health and didn’t specify an agency. The discharge planner made the referral to another agency. When the patient arrived home, my client did a post hospital visit and re-ordered colostomy supplies. After the post hospital visit, the aide continued to see the patient to assist with personal care after surgery.

      On the third visit, the aide noticed a folder from a competing agency. They were contacted by my client and insisted that they got the patient fairly and refused to give up the patient. The patient was devastated and my client lost a ton of money.

      Had the receiving agency checked the medicare online system as required in the regs, they would have seen the patient belonged to another agency. Furthermore, the patient knew nothing about a new agency and the patient was not told that all supplies and services would be covered by the new agency as required.

      Alas, this is not an unusual story. You are very fortunate to practice in an area where the only time patients change agencies is because the first agency is giving poor care. There are some very aggressive marketers out there and mistakes are made unwittingly by both physicians and discharge planners.

      So, my advice stands. And to be certain, your opinion is respected.

      As far as my business practices are concerned, I like what I do. The number of clients I get from writing the blog are few and far between but I like being part of the larger home health community. And when I do have potential new clients, I always refer them to the blog so they can get an idea of who we are and how we think. But make no mistake, making money by helping agencies be successful by taking excellent care of their patients is a good thing on my planet. Helping my fellow nurses, with or without pay, is even better.

      Like

      December 13, 2010

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