Assistive Living Billing

Can someone tell me the process an assistive living goes through in billing it's residents? My husbands mother keeps getting informed that her mother's "Levels" are increasing, causing a significant raise in her bill. I do not see a big change in her condition and they certainly are not doing any extra for her. I suspect some billing fraud and want to know what to look for when I audit her chart.

This is in Ohio, if that matters much. My poor mother in law is at her wits end because there is only so much money left for her care.

thanks,
Laura
I am not exactly sure how it works but I did find these websites that may help you out or give you something to go by!http://www.canhr.org/RCFE/rcfe_costs.htmhttp://www.longtermcarelink.net/elde...ted_living.htm - scroll down to COST!Hope this helped you some!

Typically nurses are not involved in billing whatsoever so idont think you will get much response here......

I did get a few suggestions. I posted it here because I didn't know if there was a MDS type billing for case mix scores since they keep saying the documentation warrants a higher level. In the hospitals, they can't bill if it isn't documented, and wondered if it was the same in assistive living.

You can do some basic 'auditing,' but if you really suspect billing fraud, you should get an attorney involved. (eek, I can't believe I just said that )

ask to see the criteria for those "levels" and then check the documentation to see if the care given matches the criteria. alas, assisted living is usually private-pay, so they can make it up as they go along, but the policies should be dated and you can correlate c her dates of care. be sure to come armed with a signed hipaa release from your mother in case they say they can't show you her records "because of hipaa." you can download generic ones off the net, and you should have one for her anyway.

Quote from Laurab14Can someone tell me the process an assistive living goes through in billing it's residents? My husbands mother keeps getting informed that her mother's "Levels" are increasing, causing a significant raise in her bill. I do not see a big change in her condition and they certainly are not doing any extra for her. I suspect some billing fraud and want to know what to look for when I audit her chart. This is in Ohio, if that matters much. My poor mother in law is at her wits end because there is only so much money left for her care.thanks,Laura

Ask for an itemized bill and an explanation of what caused each level of care rise. Then ask what care is being provided for your MIL that caused these "levels" to rise.If you don't get an answer, ask again, and keep asking until you get an answer you can understand.

No experience in AL or billing and my MDS experince is distant....Does she need more assist with adls? Now incontinant? Wounds? Help with feeding or bathing (adls) different type of meds? maybe injections or blood sugars? Behavior monitoring or any pt education? I'd just ask what the specific changes are in the level of care? If she has declined...don't they need to tell you? Do they have any type of family conferneces?

This might be something better handled with the ALF where your MIL resides. Since ALF's typically are completely self-pay, its a matter of what the market will bear as to what is charged.

I will merge these two threads are they both discussing the same topic.

I just started sitting down with family members for the biannual assessment of their loved ones, so that i could show them where the "point totals" that are used to determine the care levels come from. Service plans and care levels are much like the much beloved care plans. Their are actions that are being implemented to reach a goal. Sit down with the resident care director and have them go over it, point by point.

Something that may be of use to the OP:Looks like Ohio has an elder care ombudsman program - I don't know all that much about it or how effective it is, but here's a link to it: http://aging.ohio.gov/services/ombudsman/default.aspxI do know that the one here was sort of iffy (sided with the facility more often than not - had to point out what they were advocating was a violation of state law), and that there are regulatory agencies that determine at least to some extent what facilities charge & when they can do rate changes (at least in California.) Had the quasi-pleasant experience of dealing with them when I managed my late mother's care, 'cause it turned out that my mother's caregiver in the RCFE she was staying at didn't inform us correctly & insisted we were entitled to a partial refund. Had to inform them that (a) the money was already paid in "good faith", and (b) the refund would in all probability nail my mom right in the "share of costs" corner and in all likelihood cost her her MediCal benefits.And people wonder why family members caring for elderly relatives tend to be kind of goofy at times...THAT I don't miss a bit! Best of luck, and let us know how it goes for you!----- Dave