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Chronic Patients Can Qualify for Medicare Coverage - Posted: November 10, 2008
A common misunderstanding is the belief that “chronic” patients do not qualify for Medicare coverage because they will need services for a long time. Consider this question.
We have a patient we see under the Medicaid Waiver Program for monthly Foley catheter change. She also has an ileostomy that’s cared for by her daughter. The durable medical equipment (DME) representative stated that since this person has Medicare, she should be under skilled nursing services and we should be providing supplies. We see her for her chronic diseases, so I don’t see how she meets the criteria. [MORE]
Homecare Aptitude Test: The Qualifying Service - Posted: November 03, 2008
On October 6, 2008, the Centers for Medicare and Medicaid Services (CMS) took several actions to control suspected fraud in the Miami area. The investigation leading to these actions targeted diabetic patients receiving daily visits for insulin administration. The CMS found evidence that many patients did not qualify for Medicare coverage. Test your knowledge about the initial visit and qualifying service with these true/false questions.
- Start of care orders note six physical therapy visits and one skilled nursing visit. The physical therapist can make the initial visit because therapy is the qualifying service.
- Just about every patient discharged from the hospital can qualify for observation and assessment.
- If there is no caregiver to perform a wound care procedure, Medicare will cover nursing visits to do this.
- In most cases, a single physical therapy visit will qualify a patient for continuing occupational therapy.
- Medicare will cover intermittent nursing visits for skilled treatment of a stasis ulcer that the physician believes will never heal.
[MORE]
It’s Time for P&P to Step up to the Plate - Posted: October 27, 2008
The World Series has begun, with baseball players stepping up to the plate to help their team win the big game. In the world of home health care, policy and procedure (P&P) can help an agency succeed by providing processes where nothing exists in regulation. Here are just a few questions that good P&P can answer.
• What are the minimum requirements for a home health administrator?
• Must a home health agency have a medical director?
• What are we supposed to do about in-service education for nurses and therapists?
• How can we handle on-call after the office is closed?
• When a patient falls, whether it is witnessed or not, is there any regulation about how to document it? [MORE]
Handling a Change in Condition During the First Week - Posted: October 20, 2008
The initial assessment gathers information about the patient’s condition and needs with which an agency plans care. What happens if there is a change in condition shortly after the clinician completes the assessment. A director writes:
Can we change responses in the initial assessment to reflect a change in status? We admitted a patient and reported on the OASIS and plan of care that she was alert and oriented. But then on day five, she presented with extreme confusion and disorientation. Can we recall the start of care OASIS and change the responses to match her current state. But what about the plan of care? We already sent that to the physician. [MORE]
Facts Clear up What Lawyers Don’t - Posted: October 13, 2008
Just because lawyers know the law and work with homecare agencies doesn’t automatically make them experts on homecare billing. Here is an excerpt from a law firm’s recent newsletter to its home health clients.
“Beginning in 2008, home health agencies will begin billing for supplies. A hint to assist you in smooth transition to supply billing is to please take note of the language or verbiage used by the payer for home health supplies. If you misname the supplies, the computer program that double checks claims and payment might not recognize your supplies as proper…. Go ahead and learn the ‘proper names’ and coding for the supplies early.” [MORE]
Homecare Aptitude Test: Initial Visit Decisions - Posted: October 06, 2008
The admitting clinician faces many important decisions during the initial visit. One of the most important must be made within the first five minutes: Does this patient qualify for Medicare coverage? If so, the clinician can move right into the initial assessment. If the clinician makes the wrong decision, there can be multiple and serious repercussions. Test your skills at making quick decisions under fire.
- The patient, a blind diabetic with no willing or available caregivers, spends four days a week at a sheltered workshop participating in social activities. His travel by handicapped van involves taxing effort and assistance. Is this patient homebound?
- During the initial visit, the physical therapist learns that the patient has no need for physical therapy but she is homebound and definitely needs occupational therapy. Does this patient qualify for Medicare coverage?
- The patient with multiple sclerosis qualifies for coverage of skilled nursing. She requires assistance with transfers in the morning and evening. Her husband requests daily aide visits in the morning to assist his wife; he will continue with the evening care. Will Medicare cover daily aide visits for this patient?
- The physician has indicated that the homebound patient will need three months of daily skilled nursing visits to treat problematic wounds. Does this patient meet the Medicare requirement for intermittent skilled nursing?
- A daughter requests the homecare agency to provide physical therapy to her father while at a day-care center. He is not safe at home and she works full-time. Would he qualify for coverage?
To test yourself and to find the answers, click on — http://www.beaconhealth.org/visitdecisions/visit_decisions.html[MORE]
How Are You Doing under the Revised PPS? - Posted: September 29, 2008
These days, everyone is looking for a little relief.
Visit us at NAHC's 27th Annual Meeting in Ft. Lauderdale, Fla., October 12-14, and discover how Beacon Health can help you and your agency prosper.
See us in Booth #815 and reap the benefits:
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Receive a FREE educational audio CD on the PPS--a $49.95 value!
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Enter our drawing for a chance to win a $200 VISA® gift card.
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Attend FREE in-booth educational presentations:
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"How to Handle a Change in Condition, Supplies, and Therapy"
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"7 Facts about Reporting and Documenting Nonroutine Supplies in the PPS"
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Try out our new interactive in-service CDs that explain how the PPS works.
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Meet Diane Omdahl, RN, MS--homecare's premiere educator and advisor.
You'll also discover great deals on great products:
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Take 20% off your purchase when you order from our catalog at the show.
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Take 20% off PLUS take an additional 10% off when you order from our "Show Specials" brochure.
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Save $100 when you register for our new 2009 Mastering Medicare seminar, "Documentation and Coding," in Orlando, Las Vegas, Nashville, or Chicago.
This year's NAHC Meeting promises to deliver lively discussions of issues that affect you and your agency. As you make the rounds, be sure to stop by Booth #815. See for yourself why Beacon Health has been a trusted source of guidance for more than 21 years. We look forward to seeing you in Ft. Lauderdale! [MORE]
There’s More to the HHRG Than Meets the Eye - Posted: September 22, 2008
As homecare providers become more familiar with the Home Health Resource Group (HHRG) Four-equation Model, they will need to know about every piece of the puzzle. Here’s a question from an agency administrator.
Can you explain briefly how the numbers, such as “Clinical C1: 0-4, C2: 5-8,” in Table 3 of the Four-equation Model relate to Table 2A? I thought I understood it but when it comes down to teaching someone else, I am having a difficult time.
[MORE]
How HIPAA-savvy Are You? - Posted: September 15, 2008
Here’s a question to check your knowledge of the Health Insurance Portability and Accountability (HIPAA) privacy standards.
If the patient dies, does the next of kin or power of attorney (if not the same person) have the right to access protected health information (PHI) or request an accounting of the PHI that has been disclosed? [MORE]
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