When the Department of Health catches wind that a healthcare provider is falling below standards, the investigations to follow scrutinize everything, including transportation.
Recently, there have been allegations about some of the larger skilled nursing centers in Pennsylvania providing sub-par care and inaccurate records. These allegations almost always launch full-scale investigations into every aspect of these facilities, and tend to bring more focus to nursing homes and other healthcare providers in general. To read about a local example currently under investigation, click here.
When there is any suspicion, it’s always comforting to know that there are professionals that you can count on. Healthcare provider investigations leave no stone unturned so that we can all be sure that the care that we’re paying for is the care that we are getting. These searches thoroughly scan the plan of care, and each step along the way. That includes transportation services.
Compliance with regulations is the key to ensuring that all standards are met and exceeded. One of the major issues under scrutiny in the facilities under investigation is compliance with pricing regulations. Because many patients at skilled nursing facilities are covered by Medicare, the state is responsible for ensuring that healthcare given is appropriate for the costs charged. As a patient, it is also important for you to know what your medicare coverage provides.
If you have Medicare (Part B), some transportation services are covered, and all you would pay out of pocket is a deductible in some cases, if any. Medicare generally covers emergency transportation to the nearest hospital or other nearest care center. If a different, further care center is needed or preferred by the patient, Medicare generally covers costs based on the closer care center. Medicare may also cover some non-emergency transportation services if necessary.
In addition to Medicare pricing regulations, the legislature has also enacted a statute to protect patients financially. “Anti-kickback” statutes prevent healthcare providers from overcharging, giving a facility below cost service in order to obtain Medicare patient referrals, double-charging and requesting payment for services that haven’t been provided. Healthcare providers are also prevented from providing unauthorized services, or services that aren’t covered under insurance. Transportation services, for example, must provide patients with an Advanced Beneficiary Notice of Non-coverage if the service believes that Medicare may not cover its costs. Pennsylvania is one of three states that are piloting a program that would allow patients that need regular transportation to ensure that Medicare covers the transportation before it is needed.
Ensuring that every provider along the way is compliant with statutes and regulations is one of the ways that you can protect yourself and your loved ones. When choosing services, check your coverage plans, call ahead and ask questions. Also, things like Public Utility Commission (PUC) licensing and compliance can give you a hint about how the transportation service meets or exceeds standards in other ways.