An ortho client emailed an interesting question this past week that is a good one to think through. For post-op major joint replacement patients, they would like to send their RN to the patient’s home for follow-up check-in visits. They wanted to provide this as an optional cash pay service.
As a compliance forward auditor, our first reflex is “Absolutely no! This is global care!” However, after conferring with a good health law attorney friend of mine (you know who you are!), the RN visit would not be covered no matter what it was for.
Where the patient wanted that option, the practice, with appropriate disclosure of the non-covered nature of the service and as such would not be billed, could then charge cash for the service. It is always best practice to err on the side of compliance, but it is even better practice to know when to ask someone else who may know the topic a bit better and receive the BEST answer. Not every sour revenue story has a positive ending, but today, this one does because we took an extra step!
Exhaust every step before you say no.