Nursing home billed as an inpatient charge for mother on Medicaid

[ChristinaC71503]

Hello. I have never seen this, and if my mother were not moribund, and I wanted to take one last look at things before she dies "in a few days," I noted a high and bizarre charge billed to Medicare, which they paid, and because she has full Medicaid, I presume they got resident bed money through that route too. It seems they are double-dipping, but perhaps it is no different than when she goes to the real hospital and I think some money is paid to the facility to hold her bed. I cannot be certain of this because the piece I am missing is what Medicaid pays when she goes to the real hospital. They recently bill out a 14 day elective hospitalization, which is a farce. They moved her, after making sure she got infected with Covid, and is why I believe she is dying, to another wing, with no further amenities, and the same roommate to boot. How can she both be a resident under LTC Medicaid AND be a "hospital" inpatient? Has anyone ever seen this before?

Thanks!

[somarco]

@ChristinaC71503 if your mother is "dual eligible" then Medicare and Medicaid will be billed.

Medicare pays first, and Medicaid pays second.

Medicaid never pays first for services covered by Medicare. It only pays after Medicare, employer group health plans, and/or Medicare Supplement (Medigap) Insurance have paid.

https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicaid

[ChristinaC71503]

Well, except for those items Medicare does not touch, LTC room & board in a nursing home this case.

[somarco]

@ChristinaC71503 if you have POA you can take up the matter with Medicare/Medicaid.

[ChristinaC71503]

My mother passed early AM on November 21, about 9 1/2 hours after I started this thread.

I am not so sure I can do anything as FPOA. I read recently that my powers expired with her death. However, I am making a stink and have two people with my state's Attorney General's office listening. Right now, my mother's Medicare account is being "watched" by someone at that office. I left a VM with the Senior Medicare Patrol, which is only reviewed once a week.

I am not sure when I will be able to "wag" again. 

[GailL1]

Maybe it was for Hospice care - although if you are the Healthcare POA they should have informed you or they could have informed whomever is her healthcare POA, if she has one.

Medicare.gov - Medicare Hospice Benefits

Medicaid.gov - (CMS) An Overview of the Medicaid Hospice Benefit

Medicaid coverage for her room and board at the facility is paying for her residence - i.e. where she currently lives in the facility.  That is different from her actual medical or health care which is covered either by Medicare or Medicare/Medicaid.  

Hospice care is  total care for a person who is at the end of life stage.  The links explain it in more detail.

Many times, Medicare acts as coordinator for Hospice care.

It is sometimes very stressful to deal with knowing a person that you love is at the end of life.  Just take care of the things that will make her the most comfortable - she should be pain free, her physical hygiene needs should be taken care of, if immobile, she needs to be rolled, maybe some cream massaged delicately.  You can try to be there as much as possible and giving her your support and caring although she may not act as though she knows you are there.  Be calm and try to take any anxieties out of the room she is in - 

It's life, Christina - it is a human progression.  As my husband said before he died . . . . I am ready for the next adventure.  

[ChristinaC71503]

Hospice only started Tuesday. EOB was for 14 days starting October 18.

I am her health care agent as well as FPOA. All things must come through me.

She was in much pain Tueday afternoon when I finally got to meet the hospice nurse. The facility had been giving her Mickey Mouse medications: ibuprofen, Tylenol, plus she could not swallow them, even crushed into a paste in an attempt to slide a piece of paste down her throat with some ice cream. I would like to lump Tramadol in there as Mickey Mouse.. It used to be effective then it was not, but they still kept giving it to her. The hospice nurse said it was because of her CKD. I say my mother and I and a prescriber should have been able to discuss other medications, in terms of pain relief versus shortening of her life, and then selected one. I would say from statement along the lines of "I am sick of it," would have leaned toward effective pain relief, a bit shorter life, and if GFR dropped to dialysis level, treat her for her symptoms but no to dialysis. She was started on morphine drops Tuesday night, presumably, For a Friday AM pet Zoom meeting, she was in horrible pain again.

I received my first call EVER on a medical update tonight in the 3 1/2 years she has been in that s-hole. I am pretty concerned when I was told the morphine drops were stopped and she was not in pain. I don't believe them. I know what I witnessed on Zoom less than 36 hours before. Unless there is some sort of natural painkillers being released after reaching a certain point in the dying process, it's just not possible to go off morphine and be pain-free.

[ChristinaC71503]

Regarding Tramadol, that may have been a lie too. The last time it was billed to Part D was back in March. 

Update: She passed away alone very early in the morning on November 21. Bayada could not get it together to arrange for that last ride for me. Very corporate, with their 2-minute answers, and then going quickly to email, which never gave me a chance to clarify the instructions on their free ride offer to be with at or near the end. A sour taste in my mouth all around. The death certificate was incorrect in many aspects, the most important was leaving out her recent infection with COVID. "Failure to thrive." Yeah, how many thrive when infected with COVID and just after. I put the line about her date of infection with COVID into her obituary. People may draw their own conclusion.

[RachelE440067]

Hello Christina,

My name is Rachel, and I'm a reporter who writes about medical language for The New York Times. I came across your post while I was looking into the origins of the phrase "failure to thrive," and the ways it can affect patients and their family members. I am so sorry to read about your loss, and how frustrating your mother's medical experience was at the end of her life. If you were open to it, I'd like to ask you a few questions about your experience, and how you felt about the phrase "failure to thrive" on her death certificate, given that she also had COVID. I also completely understand if this is a time you'd rather not revisit. I can be reached at rachelegross@gmail.com. Thank you for considering, and I'm so sorry again.

My best,

Rachel