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Livanta does the appeal process very fast, like 24-72 hours. & they let the provider know by phone as well as online. Has this happened?
FWIW here’s this weeks health policy wonk factoid: Livanta is an outside contractor for CMS. CMS / Centers for Medicare & Medicaid is the federal hub for everything Medicare and the federal side for Medicaid. CMS has a HQ & regions and Livanta does appeals for Region 2,3,5,7,9. Livanta handles the Medicare appeals process + SSR (short stays) + HWDRG (complex diagnosis) and done online via a review of the Medicare beneficiary health charts (which are already in CMS system as Medicare is paying). Like when you go into rehab from a post hospitalization stay, both are paid for by Medicare as your primary health insurance. And Medicare pretty much requires for all data to be entered in order for an approval to happen (& therefore for a payment to happen so it flat gets done) and then it’s updated SUPER regularly. Like basically daily. So the Livanata review is done based on all the existing data that has been entered almost in real time so it’s a pretty solid decision.
Queenhold, a facility is not supposed to discharge patients until appeal determination is done. Medicare is strict on this as they require a CONTINUUM OF CARE approach from any place getting Medicare $. What I’d suggest you do asap - like today - is sit with billing or SW at the NH and they go into ARROW. Arrow is the online portal for providers in Livanta service area to see the status of a patient. The website is livantaqio.cms.gov. Your family member has a patient # and they are there on a type of care plan. So if you are in New Jersey, it would be NJ-12345 (patient#)-AP (type of care plan). determination are quite fast.
Doing an appeal is not uncommon. Ancedotally it seems to have really increased in the postCovid landscape, but that’s another story for why happening. It could be that the SW has seen and many times before patients with the same care needs / plan and the SW know the appeal is dead in the water, there is nothing more they can do under the Medicare based reason for care, so they are trying to get across the point that anything Medicare pays for is over and you/POA have to make a decision asap as to where your family member is to be discharged to. If a return home is out of the question, then you have to let the place know how the transition from being a patient under Medicare to then a custodial care resident staying put will be paid for. Or what other facility they are moving to so they do the discharge report to send to the new place. And someone in the family will have to take the lead in all this, do whatever needed. Like if it’s LTC Medicaid bed where they currently are, someone has to get documents needed and sign off on admissions, billing, etc. You should straight out ask the SW if your family member can stay there, there is always the possibility that this place cannot have him stay there.
Try to stay calm, it’s easy to get overwhelmed as most of us never have had to deal with all this all at once plus deal with family drama as well. Do realize that SHOULD the family do nothing, the facility will do a 30 Day Notice which is basically an eviction notice. It gets Cc’d to APS and a probono legal center in the region. And will bill whomever they can in the family full private pay rate for every day your family member is there.
Is your Uncle in Rehab? Because from what I just read Livanta is Medicare which only pays for rehab.
This is just my opinion. If an appeal is in the works, then I would say no. You may want to call Medicare for that answer. Has uncle reached his 100 days that Medicare allows? If so, then he needs to be transferred to Long-term care with Medicaid pending if he can't afford private pay. Some LTC facilities will not do Medicaid pending. You can call an Ombudsman asking if the SNF can force Uncle out during an appeal.
Medicare only pays 100% the first 20 days. From 80 to 100, 50%. Your Uncle is responsible for the other 50% either personally or thru supplimental insurance. After 100 days Medicare will not pay. If Uncle needs more care he needs to go into LTC on his dime or apply for Medicaid.
Care, yes if the SNF is not being paid, I think, they can stop Physical Therapy. They still have to feed, give the patient meds and care for physical needs I am sure. Another question for an Ombudsman.
I would call whomever is handling the appeal process. I honestly do not know. You may just need to say that the appeal is still being processed and hang up the phone. There isn't much of a place for the SW to go with that response.
I just tried to find anything regarding the legalities of this online and was met with a deluge of information, none of it giving the information you need.
I am hoping Igloo, or any SWs we have on site have a clue of what to tell you; I sure don't.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
FWIW here’s this weeks health policy wonk factoid:
Livanta is an outside contractor for CMS. CMS / Centers for Medicare & Medicaid is the federal hub for everything Medicare and the federal side for Medicaid. CMS has a HQ & regions and Livanta does appeals for Region 2,3,5,7,9. Livanta handles the Medicare appeals process + SSR (short stays) + HWDRG (complex diagnosis) and done online via a review of the Medicare beneficiary health charts (which are already in CMS system as Medicare is paying). Like when you go into rehab from a post hospitalization stay, both are paid for by Medicare as your primary health insurance. And Medicare pretty much requires for all data to be entered in order for an approval to happen (& therefore for a payment to happen so it flat gets done) and then it’s updated SUPER regularly. Like basically daily. So the Livanata review is done based on all the existing data that has been entered almost in real time so it’s a pretty solid decision.
Queenhold, a facility is not supposed to discharge patients until appeal determination is done. Medicare is strict on this as they require a CONTINUUM OF CARE approach from any place getting Medicare $. What I’d suggest you do asap - like today - is sit with billing or SW at the NH and they go into ARROW. Arrow is the online portal for providers in Livanta service area to see the status of a patient. The website is livantaqio.cms.gov. Your family member has a patient # and they are there on a type of care plan. So if you are in New Jersey, it would be NJ-12345 (patient#)-AP (type of care plan). determination are quite fast.
Doing an appeal is not uncommon. Ancedotally it seems to have really increased in the postCovid landscape, but that’s another story for why happening. It could be that the SW has seen and many times before patients with the same care needs / plan and the SW know the appeal is dead in the water, there is nothing more they can do under the Medicare based reason for care, so they are trying to get across the point that anything Medicare pays for is over and you/POA have to make a decision asap as to where your family member is to be discharged to. If a return home is out of the question, then you have to let the place know how the transition from being a patient under Medicare to then a custodial care resident staying put will be paid for. Or what other facility they are moving to so they do the discharge report to send to the new place. And someone in the family will have to take the lead in all this, do whatever needed. Like if it’s LTC Medicaid bed where they currently are, someone has to get documents needed and sign off on admissions, billing, etc. You should straight out ask the SW if your family member can stay there, there is always the possibility that this place cannot have him stay there.
Try to stay calm, it’s easy to get overwhelmed as most of us never have had to deal with all this all at once plus deal with family drama as well.
Do realize that SHOULD the family do nothing, the facility will do a 30 Day Notice which is basically an eviction notice. It gets Cc’d to APS and a probono legal center in the region. And will bill whomever they can in the family full private pay rate for every day your family member is there.
This is just my opinion. If an appeal is in the works, then I would say no. You may want to call Medicare for that answer. Has uncle reached his 100 days that Medicare allows? If so, then he needs to be transferred to Long-term care with Medicaid pending if he can't afford private pay. Some LTC facilities will not do Medicaid pending.
You can call an Ombudsman asking if the SNF can force Uncle out during an appeal.
Medicare only pays 100% the first 20 days. From 80 to 100, 50%. Your Uncle is responsible for the other 50% either personally or thru supplimental insurance. After 100 days Medicare will not pay. If Uncle needs more care he needs to go into LTC on his dime or apply for Medicaid.
Care, yes if the SNF is not being paid, I think, they can stop Physical Therapy. They still have to feed, give the patient meds and care for physical needs I am sure. Another question for an Ombudsman.
You may just need to say that the appeal is still being processed and hang up the phone.
There isn't much of a place for the SW to go with that response.
I just tried to find anything regarding the legalities of this online and was met with a deluge of information, none of it giving the information you need.
I am hoping Igloo, or any SWs we have on site have a clue of what to tell you; I sure don't.