What is the story with DVA and EPC referrals for residents in aged care facilities?
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I am servicing several aged care facilities and am finding the different in-house practises regarding billing interesting...
One facility has basically all its permanent residents on DVA or EPC referrals regardless of whether they are high care or low care
Another had this but when it was taken over by another organisation and changed from being shire-run to being privately run, the residents were reassessed resulting in most of their statuses being changed from being low care to high care. They then advised me to cease billing their high care residents' treatments to DVA/Medicare as their understanding is that high care residents are not eligible for treatment under DVA/Medicare
Another says their residents are ineligible for DVA/EPC referrals because they live in an aged care facility
The facility that has most of its residents' treatments being billed to DVA/Medicare fill out the paperwork (they produce the care plan) and give it to the GP who signs off on it. The GP does not seem to see the residents to check that their care plan is appropriate
The one that has ceased having their high care residents on DVA/EPC referrals was taking their residents to the GP for care plans to be done
So at the end of the day I'm confused about the following:-
1. are people in residential aged care facilities eligible for DVA/EPC referrals? Is it just low care residents that are eligible or are high care residents eligible too?
2. if they aren't and I get audited, will I have to repay the money to DVA/Medicare even though I had nothing to do with organising the referrals?
3. is it worth the headache of explaining to the residential aged care faility and or the GPs that what they are doing may not be correct/legal and risking them changing to another (less concerned) service provider?
4. if these residents aren't eligible, surely the practice nurses/practice manager/GP would be aware of that - what happens if and when they get audited? How far down the line will the audit tidal wave travel?
5. for those residents in state-run/managed facilities, should they have access to DVA/Medicare at all? Aren't DVA and Medicare federally-funded bodies? Is this state-run facilities palming off some of the costs they should be wearing onto the federal government?
Any thoughts/answers out there?
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