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an article first published in 'The Coders Voice' on 9/1/11.
On Monday, many of the patients who had been evacuated from hospitals and nursing homes in advance of Hurricane Irene were transferred back-leaving financial chaos in the hurricane's wake.
Sorting out the billing for the evacuations and patient transfers could take days. Patient care, staffing, transportation, ambulances, food-all of it must be reimbursed. Patients were transported in ambulances, ambulettes, buses and, in some cases, by private car. Medical staff visited their patients at their temporary quarters. Costs were incurred by both the evacuated and receiving institutions.
"The question is, who pays for what? Who bills for the services and costs incurred?" said Richard Herrick, CEO of the New York State Health Facilities Association, a long-term care facility trade group.
Evacuation of a nursing home is a rare event, he added, but in this case, roughly 15 homes in the state were evacuated. "The scale of this event was unprecedented," he said.
Many questions have arisen. What is the Medicare and Medicaid reimbursement policy with respect to the transfer of patients between institutions? If a federal disaster area is declared, do the feds pick up the tab? How will private insurers pay for the costs incurred?
On Tuesday, New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie requested an expedited major disaster declaration from the federal government to help deal with the storm's aftermath.
Last Friday, Greater New York Hospital Association raised the issue with its members. The trade group got assurances from the state Department of Health that Medicaid will provide appropriate compensation to both the receiving and transferring facilities. The hospital association also informed members that the health department asked Medicaid managed care plans and commercial insurers to relax utilization controls and network requirements so that patients could receive services if they relocated.
The health department is looking at several possible reimbursement models, and will check with the federal Centers for Medicare & Medicaid Services to make sure they meet federal guidelines. The state health department also will address reimbursement issues on its website.
A Centers for Medicare & Medicaid Services spokesman said that if a hospital needed to transfer a Medicare patient because of an emergency evacuation, the normal transfer payment policies would apply. "The payment would not be dependent on the formal declaration of an emergency," he said.
Mr. Herrick said that he hoped reimbursement decisions would be made within 10 days so that nursing homes won't have to wait for payment. But, he cautioned, "my assumption is some costs will never be reimbursed.
"It is a very fragile time financially for nursing homes, and I have to think they showed a tremendous amount of good faith that it will all turn out positive," he said.
By Monday afternoon, nursing home patients were still being transferred back to their home institutions, said Neil Heyman, president of the Southern New York Association, which represents nursing homes in the New York area.
He estimated that about 5,000 nursing home residents were involved in evacuations in New York City's Zones A and B. Some nursing homes chose to shelter-in-place because there were not enough beds at other facilities.
"There were a few things that didn't happen according to script, but overall, the evacuations worked," he said. He describes the crisis as a "fantastic learning experience. We got everyone to safety in a remarkably short period of time, which shows how wonderfully cooperative people can be."
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