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:
- The receiving agency must contact the prior agency to let them know of a beneficiary elected transfer.
- 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.
- 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 firstname.lastname@example.org. As always, we welcome your comments and questions.