Oxylated: Part 5
    I just did a little checking.

• For the month of January of this year, which was a heavy use oxygen month, our oxygen company billed Medicare/TriCare almost exactly half of what they supposedly told IHNTL they "lose" on my mother.
  Medicare/TriCare paid our oxygen company 58% of what our oxygen company billed them.
• For the month of February of this year, also a heavy use oxygen month, our oxygen company bill Medicare/Tricare a little more than half of what they told IHNTL they "lose" on my mother. Medicare/TriCare paid our oxygen company 56% of what our oxygen company billed them.
• In addition, Medicare, alone, paid a little over 100% more than our oxygen company told IHNTL they receive from Medicare every month.

    I understand creative bookkeeping and I realize that in many medical instances it is not only legal, it is the only way medical companies manage to make ends meet. I don't have a problem with this kind of creative bookkeeping, as long as our government in this country refuses to regulate the medical-industrial complex. Considering a certain contingency regarding our own oxygen company, though, mentioned in Oxylated: Part 2, I find it difficult to believe that our oxygen company is one of those companies that is struggling to survive.
    Last night I received yet another call from yet another Hospice nurse who wants to visit with my mother and me. She asked if we had any needs. I stuttered a bit, then related the entire story of IHNTL's Thursday phone call. I also covered what I'd been thinking since the call and the research I will be doing tomorrow regarding finding out if our Hospice company is a TriCare provider. I concluded by telling this Hospice nurse that our "need" is that we do not "need" this sort of billing problem thrown in our laps and negotiated in such a way as to make our lives harder than they already are.
    This new Hospice nurse was obviously clueless about TriCare and its policies regarding Hospice providers. She explained to me that "Medicare Hospice" is a completely different system than "Medicare" and involves a "pot" out of which Medicare pays Hospice bills. No other insurances come into play (which is actually different than other information I've been given about this Hospice provider and private insurers). I responded by telling her that TriCare also has a "Hospice pot", but a Hospice company can only dip into that pot if they have been approved as a TriCare Hospice provider and my research tells me that this company may not have sought this approval, which I find astonishing, considering that its administrative umbrella, the local hospital, is listed as a TriCare provider. I told her that I don't understand how this Hospice company is "excuse my French, kicking itself in the ass regarding funding" by not being an approved TriCare provider. I told her that I downloaded and printed a section of the TriCare Reimbursement Manual involving Hospice and discovered a section that lays out the process of applying for TriCare approved Hospice status and that it seems not only straighforward but is simply a matter of being Medicare approved (which our company is) and filing paperwork. I concluded by telling her, at this point, it looks as though there are three ways to solve this oxygen billing problem:

1. Our Hospice quickly become a TriCare approved Hospice provider;
2. Our Hospice declassify my mother's oxygen as connected to her lung cancer so that her normal Medicare/TriCare coverage can subsidize it as before, which should satisfy our oxygen company;
3. Mom and I switch Hospice providers.

    I summarized with two points:

1. Our hospice should do everything they can not to be held hostage by our oxygen company's creative bookkeeping;
2. My mother and I would prefer not to have to make a switch, but if we have to, we will.

    The new Hospice nurse told me that she isn't involved in finances, the IHNTL is, and she will surely pass on the message.
    You may wonder why I bothered to go through this with a member of our Hospice team who isn't directly involved in finances, especially since I knew, ahead of time, that I was speaking with such a member. Well, you know, she asked what our "needs" are. So, I told her.
    At this point, I can't wait until tomorrow. I am sure that I will find, bright and early, that our Hospice company is, indeed, not, a TriCare provider. I expect I will also find out that, for some reason to which I may not be privy, our Hospice company will be reluctant to apply for TriCare provider approval. If this happens, I will, of course, immediately be on the phone with the two TriCare approved Hospice providers serving our area. I will, among other questions, ask who their oxygen/medical equipment provider is.
    In the end, it looks as though both our current Hospice provider and our oxygen/medical equipment provider will lose about a week's worth of adequate payment for their services, including medications and durable medical equipment. I'm concerned about this, but it isn't something I can prevent.
    I should have researched our current Hospice provider; however, I believe I made a reasonable assumption that since their administrator is TriCare approved, they were, too. At least I'm catching the error of my assumption before too much havoc has been created.
- posted by Gail Rae @ 10:57   email  this post