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Frisco2020 Asked May 4, 2024

Can a SNF not provide Skilled therapy MED B services to a resident who is showing functional decline but owes the facility money?

Increased falls, pain loss of strength and AROM resulting in resident being unable to perform self-care and feeding self. Currently uses a walker.

JoAnn29 May 5, 2024
It all depends, I guess. Yes, therapy is paid by Medicare but not indefinitely. The person needs to be able to participate and be cooperative. And you know, Medicare determines how long that PT will last. If your given the complete number of days for PT, it takes a certain number of days to get it again.

Are you able to call Medicare and find out if resident is entitled to therapy. Have you talked to the Doctor who would order it.

Just a thought, maybe Medicare pays for the therapist but not for the actual use of the equipment and the therapy room. Those are included in the residents monthly rent? By law the facility cannot release this person unsafely. Without paying for their care, the facility may only have to provide shelter, food and the minimum of care to the resident. I would think Medicaid is being applied for and with that and the residents monthly income, therapy will be reinstated.

NHs are businesses and as such they need to make a profit.

MidwestOT May 4, 2024
Skilled therapy services and financial issues with the long term care facility are not related at all. I suspect that you are being pressured by the facility not to pick up the client. If you can, please fill in with some more information.

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Grandma1954 May 4, 2024
If I am reading this right...You are the therapist in the facility where this client lives.
Are you privy to the full account, doctors orders and family wishes?
IF you think medical services are being denied then you bring this to the attention of the clients doctor in your notes.
You could also inform / ask the medical director of the facility that Mr./Ms. Smith has not been participating in ordered PT / OT and is there a problem?
If you think that they are denying ordered therapy because the resident owes money you could ask the family if they are aware of this (you might want to look for another job before you say anything to family or report the facility to the Ombudsman's office)

AlvaDeer May 4, 2024
You say that money is owed to the facility by this client.
Is the client currently in the care of said facility now, and simply behind on payments?
What kind of care has the facility denied, and who is POA with the facts in this particular case.
I think we would need more information to try to figure what's happening here.
Sure hope you can update us.

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