Hospice Patients Alliance – Medicare, Medicaid and Private Insurance for Hospice #ardilaun

#private hospice

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MEDICARE, MEDICAID AND PRIVATE INSURANCE

The major sources of payment for hospice care are Medicare, Medicaid and private insurance, although Medicare certainly provides for the larger segment of the hospice population. Which source of payment covers for your hospice services should have little effect on the type and quality of services you receive.

Any hospice which receives reimbursement from Medicare or Medicaid must be licensed and certified by the State agency which surveys and inspects health care agencies. If the hospice is part of a national or regional corporation, the location where the hospice actually provides services determines which State performs these inspections. Most private insurers require the hospices to meet the same requirements as do Medicare and Medicaid, and to provide the same set of services included in the standard “Hospice Benefit.”

There is an additional benefit to having a private insurance company cover your hospice services: you have an insurance company “case manager” who reviews the services needed by the patient and family, and the services being provided by the hospice. Unfortunately, in some instances, some hospices do not provide all the services you are entitled to! In these cases, you need to be assertive and speak with the RN case manager, the hospice’s director or the hospice Medical Director.

If you still experience any difficulty getting the hospice to provide adequate services, do not hesitate to call your insurance company’s “case manager.” They can “go to bat” for you to get you the services you need. If the hospice still refuses toprovide the services you need, consider switching hospices. Hospices will usually “back down” and provide what you need if you let them know that you will switch. Do not be fooled by “threats” that hospice services will be interrupted or that “it’s not possible” to switch at this time.” Nonsense. You always have the right to choose whichever physician you wish and change at any time; you always have the right to switch hospices to get the services you are entitled to! If you do switch physicians or hospices, the hospice must assure a smooth transition and continuity of services throughout the change.

Because the Federal and State governments wish to “get their money’s worth” for the funds they pay out to the hospices, it is important to report any hospices who do not provide the full set of services needed to meet the patient’s needs. Since Medicare and Medicaid pay a hospice on a “per-diem” or daily basis for all the services needed, the hospice is receiving payment on the assumption that it will actually provide those services. When a hospice does not provide services needed and which you are entitled to, that hospice may be involved in “health care fraud.” You can help stop the rampant exploitation of the Medicare and Medicaid systems by unscrupulous administrators. report these violations to the Office of the Inspector General. (See “Links to Report Fraud in Hospice” at Section 10 of this text) .

Permission is granted to share these articles with others, to print them, or post them on other websites so long as credit
is given to the author and Hospice Patients Alliance with a link to this original page.





Medicare Hospice Benefit – Hospice Action Network #hudson #bay #hotel

#hospice medicare benefit

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Medicare Hospice Benefit

More than 90% of hospices in the United States are certified by Medicare. Medicare defines a set of hospice core services, which many hospices surpass through voluntary, community-based efforts.

The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of non-curative medical and support services for their terminal illness. Hospice care also supports the family and loved ones of the patient through a variety of services, enhancing the value of the Medicare Hospice Benefit.

The Medicare Hospice Benefit provides for:

  • Physician services
  • Nursing care
  • Medical appliances and supplies
  • Drugs for symptom management and pain relief
  • Short-term inpatient and respite care
  • Homemaker and home health aide services
  • Counseling
  • Social work service
  • Spiritual care
  • Volunteer participation
  • Bereavement services

Medicare has three key eligibility criteria:

  • The patient’s doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with a life expectancy of six months or less, if the disease runs its normal course;
  • The patient chooses to receive hospice care rather than curative treatments for their illness; and
  • The patient enrolls in a Medicare-approved hospice program.

Payment for Hospice:

  • Medicare pays the hospice program a per diem rate that is intended to cover virtually all expenses related to addressing the patient’s terminal illness.
  • Because patients require differing intensities of care during the course of their disease, the Medicare Hospice Benefit affords patients four levels of care to meet their needs: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care.
  • 96% of hospice care is provided at the routine home care level which is reimbursed at approximately $135 per day.
  • The Hospice Benefit rates have increased annually based on the Hospital Market Basket Index. With the advent of costly new drugs and treatments like palliative radiation, the average cost to hospices has risen much faster than the hospice benefit reimbursement rates.
  • Hospices that are Medicare-certified must offer all services required to palliate the terminal illness, even if the patient is not covered by Medicare and does not have the ability to pay.




Home Health Providers – Centers for Medicare & Medicaid Services #cheap #motels

#home health care providers

#

Home Health Providers

This page provides basic information about being certified as a Medicare and/or Medicaid home health provider and includes links to applicable laws, regulations, and compliance information.

A Home Health Agency (HHA) is an agency or organization which:

  • Is primarily engaged in providing skilled nursing services and other therapeutic services; Has policies established by a group of professionals (associated with the agency or organization), including one or more physicians and one or more registered professional nurses, to govern the services which it provides;
  • Provides for supervision of above-mentioned services by a physician or registered professional nurse;
  • Maintains clinical records on all patients;
  • Is licensed pursuant to State or local law, or has approval as meeting the standards established for licensing by the State or locality;
  • Has in effect an overall plan and budget for institutional planning;
  • Meets the federal requirements in the interest of the health and safety of individuals who are furnished services by the HHA; and
  • Meets additional requirements as the Secretary finds necessary for the effective and efficient operation of the program.

For purposes of Part A home health services under Title XVIII of the Social Security Act, the term home health agency does not include any agency or organization which is primarily for the care and treatment of mental diseases.

A Home Health Agency may be a public, nonprofit or proprietary agency or a subdivision of such an agency or organization.

  1. Public agency is an agency operated by a State or local government. Examples include State-operated HHAs and county hospitals. For regulatory purposes, public means governmental.
  2. Nonprofit agency is a private (i.e. nongovernmental) agency exempt from Federal income taxation under 501 of the Internal Revenue Code of 1954. These HHAs are often supported, in part, by private contributions or other philanthropic sources, such as foundations. Examples include the nonprofit visiting nurse associations and Easter seal societies, as well as nonprofit hospitals.
  3. Proprietary agency is a private, profit-making agency or profit-making hospital.

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Home hospice care medicare #w #hotel #south #beach

#home hospice care medicare

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Compassion. Integrity. Excellence.

Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

Families

Every patient is a unique story.
Read more.


  • Healthcare Professionals

    We support our referring physicians.
    Find out how.


  • Volunteers and donors

    Make a difference in someone s life.
    Become a volunteer today.
    Learn how.





  • Medicare, Medi-Cal, and Private Insurance – Skirball Hospice #pallative #care

    #medicare hospice coverage

    #

    Medicare, Medi-Cal, and Private Insurance

    Hospice care is a fully covered benefit under Medicare Part A and the Medi-Cal program in California. Most insurance companies also provide coverage for hospice care subject to individual policy deductibles, coinsurance, and out-of-pocket limitations.

    When a patient is considering hospice care, the insurance coverage of the patient will be reviewed and discussed with family members to be sure they understand the financial benefits provided to the patient by their current insurance carrier. If there are any questions, they will be resolved prior to the start of care.

    For an individual eligible and enrolled in Medicare or Medi-Cal, there is no out-of-pocket cost to select the hospice benefit. The hospice benefit includes full payment for all staff services, supplies, medical equipment, and medications, provided they are directly related to the hospice primary diagnosis.

    To qualify for hospice care, two physicians, generally the patient’s attending physician and the hospice physician, evaluate the patient to determine if the individual has a life-limiting illness with a life expectancy of six months or less if the disease process follows a normal course.

    Because it is impossible to know the progression of a disease with accuracy, patients may receive the hospice benefit for longer than six months provided they continue to meet the Medicare or insurance company eligibility criteria. After six months, patients are periodically assessed by hospice physicians for continued coverage.

    When an individual elects the hospice benefit for a specific disease diagnosis, they are opting out of traditional Medicare coverage and opting into the special Medicare hospice benefit. By doing this, they agree to pursue comfort and palliative measures only and not seek aggressive or curative therapy for that disease. Should other diseases develop, unrelated to the hospice diagnosis, those may be treated and covered under the traditional Medicare program.

    When all requirements are met, the following services will be covered by your health plan:

    • Physician services
    • Nursing care
    • Home health aide
    • Medical social services
    • Bereavement counseling
    • Spiritual counseling
    • Dietary counseling
    • Volunteer services
    • Physical therapy, occupational therapy, speech therapy
    • Medical equipment, services, and supplies
    • Medications for pain and comfort related to the terminal illness and approved by Skirball Hospice
    • Short-term inpatient care for pain and symptom control
    • Diagnostic studies
    • Short-term continuous care for focused symptom relief
    • Respite for up to 5 days to provide relief for caregivers

    The following services are not covered:

    • Treatment for the terminal illness which is not for palliative symptom management and is not within the hospice plan of care
    • Care provided by another hospice or home health agency
    • Private caregivers/sitter services
    • Dietary supplements unless directly related to terminal illness
    • Services not authorized by Skirball Hospice
    • Ambulance transportation not included in the plan of care
    • Supplies not related to terminal illness
    • Chemotherapy drugs or other drugs deemed aggressive in nature
    • Medications not related to the terminal illness
    • Visit to the emergency department or inpatient hospitalization without prior authorization from Skirball Hospice
    • Diagnostic studies or any treatments not authorized by Skirball Hospice

    6345 Balboa Boulevard, Suite 315, Encino, CA 91316. Copyright 2016 Los Angeles Jewish Home. All Rights Reserved.
    License #980001583





    Medicare Coverage of Home Health Care #skaket #beach #motel

    #medicare home health care

    #

    Medicare Coverage of Home Health Care

    Progressive health care professionals often encourage people to get out of hospitals and nursing facilities and into their own or family members’ homes while recovering from injury or illness. With less honorable motives, insurance companies also pressure hospitals to release patients earlier so that if they continue to receive care, it will be a less costly variety at home.

    In response to both these movements, many new home health care agencies have sprung up. You’re increasingly likely to find such an agency in your local area. Most are able to provide care for patients who no longer need high-level care in a hospital but who still require part-time nursing or rehabilitative therapy.

    When Medicare Will Cover Home Health Care

    For your home heath care to be covered by Medicare, your situation must meet this list of requirements.

    • Your doctor must have prescribed home health care for you.
    • You must require part-time skilled nursing care or physical, speech, or occupational therapy.
    • The home health care must be provided by a Medicare-approved agency.
    • You must be confined to your home by an injury, illness, or other medical condition. (If you need nursing care or other medical services but you are physically able to leave home to receive it, you might not be eligible for Medicare home health care coverage.)
    • Your doctor must help set up a care plan in cooperation with the home health care agency.

    Medicare sometimes used to also require that your condition be expected to improve with home health care, but a recent change allows you to qualify for home health care just to maintain your condition or to slow deterioration of your condition.

    If you require full-time nursing care, Medicare will not approve home health care, but it could cover a skilled nursing facility. For more information, see our article on Medicare coverage for skilled nursing care .

    What Medicare Will Pay For

    Medicare Part A pays 100% of the cost of your covered home health care, and there is no limit on the number of visits to your home for which Medicare will pay. Medicare will also pay for the initial evaluation by a home care agency, if prescribed by your physician, to determine whether you are a good candidate for home care. (Note that Medicare Part A only pas for home health care that follows a prior three-day hospital stay. Otherwise Medicare Part B (medical insurance) pays for home health services.)

    Medicare will pay for 100% of the following services related to home health care:

    • part-time skilled nursing care—usually two to three visits per week in a plan certified by a physician
    • physical therapy
    • speech therapy, and/or
    • occupational therapy.

    If you are receiving home health care for one of the above, Medicare can also pay for:

    • personal care by part-time home health aides
    • medical social services, and
    • medical supplies and equipment provided by the agency, such as a hospital bed, a walker, or respiratory equipment.

    What Medicare Will Not Cover

    Medicare will not pay for a number of services sometimes provided as part of home health care, including:

    • drugs and biologicals administered at home
    • personal care by part-time home health aides if this is the only care you need
    • meals delivered to your home
    • housekeeping services, or
    • full-time nursing care.

    If you require durable medical equipment, such as a special bed or wheelchair, as part of your home care, Medicare will pay only 80% of the costs.

    For more information on Medicare coverage of home health care, read Medicare’s online publication Medicare and Home Health Care at http://www.medicare.gov/Pubs/pdf/10969.pdf.

    Pros and Cons of Home Health Care

    The benefits of properly administered home health care can be enormous. The fact that Medicare will pay for an unlimited number of home health care visits — with no copayments — makes home care a very good financial value compared to recovery in a hospital or nursing facility—in addition to the recuperative benefits of being at home.

    Being in your own home or even that of a friend or relative is often more conducive to a speedy recovery than the impersonal and sometimes frightening environment of a hospital. You have familiar things around you, your friends and family can come and go without worrying about “visiting hours,” and they can lend a hand with your care. You have greater privacy and are free from dreadful hospital routines and late-night noise and lights.

    On the other hand, home health care is not always the best solution. Hospitals sometimes push people out the door before they are well or strong enough, and as a result the people may take longer to recover at home, or suffer more pain and discomfort at home, than they would have if they had remained in the hospital just a few days more. This is particularly true when a patient does not have family or friends available to supplement the care provided by a home care agency.

    Finding a Home Health Care Agency

    If you are interested in home health care after a stay in the hospital, or as an alternative to a stay in a hospital or nursing facility, contact a home health care agency recommended by your doctor or the hospital discharge planner. The discharge planner can even contact an agency for you. You may also get help in locating home health care agencies from a community health organization, visiting nurses association, United Way, Red Cross, or neighborhood senior center. Medicare.gov lists home health care agencies in your area and allows you to compare the quality of their service depending on past performance.

    How to Start Home Health Care

    If your doctor has not mentioned home care to you but you feel it would be a good idea, make your wishes known. If you are looking at a long period of convalescence, home health care can be a better alternative to a long siege in the hospital or nursing facility. Most doctors will prescribe home care, can give you a referral to a Medicare-approved agency, and will cooperate with the home health care agency.

    by: Attorney Joseph Matthews





    South Florida Physical Therapy #physical #therapy,rehabilitation,south #florida,injury,recovery,meddiagnostics,med #diagnostics #rehab,srs #rehab,mdr #rehab,superior #rehab,senior


    #

    Get back in the game.

    MedDiagnostic Rehab is the premiere physical therapy and rehabilitation facility in South Florida. We treat more professional athletes, doctors and physicians than any other facility in South Florida. so you can be confident in entrusting MedDiagnostic Rehab with your physical health and wellness. If you’ve sustained an injury. MedDiagnostic Rehab will get you on the fast track to recovery. so you can get back in the game.

    A network of physical therapy facilities that you can trust

    MedDiagnostic Rehab is the proprietor of the following physical therapy clinics. each providing the same superior level of quality and service that we provide to each of our patients, with locations serving Boca Raton. Boynton Beach. Coconut Creek. Delray Beach. and Lighthouse Point :


    Cadabams Rehabilitation Centre in Bangalore #mental #health #care #in #bangalore, #mental #health


    #

    Cadabams Rehabilitation Centre for Alcohol & Drug

    Access to Quality mental health care, the Vision in mind and passion to work for persons with mental health problems and shoulder the care and responsibility with family is what made Mr Cadabam M Ramesh and Mrs Sudha R Cadabam to establish an organisation to serve persons with mental health problems. As sequel to quality care offered and commitment for betterment of persons with mental health problems CADABAM’S today has evolved into country’s largest psycho social rehabilitation centre with various specialty offerings.

    PSYCHO. Social Rehabilitation Centres

    • I had PhD and doing well in USA till I was stuck by Schizophrenia which lopsided my life bringing me to streets and finally to CADABAM’S as last option. After 2 years of rehabilitation at CADABAM’S I back on track with a job and proudly talk about my journey.
    • We as family were in shambles when we approached CADABAM’S as our only son has full blown psychosis. Just few months and right medication and psycho social care, we see a different person all together and thank CADABAM’S for being so kind to us and giving our son back.
    • I thank CADABAM’S who have really given me a new life. From being beaten by my husband and taking care of whole family and children he is back as a very responsible person understanding his responsibilities and quitting his habits completely.
    • It was a nightmare worrying about my mother who had depression and was all alone in India while I was in UK with my work and family. Its almost 2 years now that she is at CADABAM’S being very happy and taken care. I thank whole CADABAM’S Team for giving my mother a new life.
    • It was a rude shock to find our son with GANJA abuse and alcohol intake. Though there was gradual change in his behaviour we never could understand that it was because of his habbits. Just few months of treatment and support of counsellors and good medication he is back to studies and doing well. I thank doctors and counsellors for all the help and support.

    CADABAM’S Group

    Gulakamale Village, Near Kaggalipura,
    17th Mile Kanakapura Road,
    Post Taralu,
    Bangalore-560082.


    Medicare Part D – Hospice – Hospice Action Network #st #davids #hotel

    #hospice medicare

    #

    Medicare Part D Hospice

    When a patient elects hospice, the hospice provides all of the care related to the terminal illness and related conditions. Patients at the end of life may also have several different medical conditions with which they have struggled for years but are not related to the terminal condition. In these cases, the other medical conditions are not the responsibility of the hospice; they are the responsibility of the patient’s primary insurer, which is usually Medicare, and Medicare Part D for medications.

    In March 2014, CMS issued guidance to the Part D provider and hospice communities introducing a “prior authorization” process for how the two groups should determine who pays for which drugs once a patient enters hospice. Members of Congress have called for CMS to slow the process and convene the stakeholders to create the appropriate communication channels and processes for prior authorizations. However, CMS has provided little instruction and absolutely no infrastructure to ensure that hospices and Part D plans can successfully implement this process without impacting patient access to medications. NHPCO and HAN have developed the Policy Points video and many other resources for Advocates and allies to better understand this complicated issue.

    Thanks to the hard work of Hospice Advocates across the country, 75 Senators and 202 Members of the House of Representatives signed on to letters asking CMS to temporarily lift implementation of current Part D and hospice guidance and work collaboratively with relevant stakeholders toward a better policy solution. To view a complete list of all co-signers, click here .

    For an comprehensive collection of resources on Part D and hospice, including an interactive timeline, visit the archives on this issue .

    Copyright 2016, Hospice Action Network. NHPCO





    Medicare Advantage Plans cover all Medicare services #gta #hotels

    #hospice advantage

    #

    Medicare Advantage Plans cover all Medicare services

    Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgently needed care .

    The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

    Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.

    In 2016, most people pay the Part B premium of $104.90 each month.

    If you need a service that the plan says isn’t medically necessary, you may have to pay all the costs of the service, but you have the right to appeal the decision.

    You can also ask the plan for a written advance coverage decision to make sure a service is medically necessary and will be covered. If the plan won’t pay for a service you think you need, you’ll have to pay all of the costs if you didn’t ask for an advance coverage decision. Get your plan’s contact information from a Personalized Search (under General Search). or search by plan name .

    Find someone to talk to

    Find someone to talk to in your state





    Humana medicare part d prior authorization phone number – Medicare all code


    #

    humana medicare part d prior authorization phone number

    humana medicare part d prior authorization phone number

    Medicare Part D Coverage Determination Request Form. This form Biotech or
    other specialty drugs for which drug-specific forms are required. [See Part D

    The LI NET Program will provide Part D prescription drug coverage for: 1. All
    uncovered The LI NET Program will be operated by Humana, Inc. on behalf of
    CMS. 2. 10/08/2009 formulary, no prior authorization Have a valid Health
    Insurance Claim Number (HICN). Are Part D eligible. Are not enrolled in a Part D
    plan.

    Provider. Medicare Part D Manual Submit claims to: Humana Claims, P.O. Box
    14601. Lexington, KY 40512 4601. A Medicare Health Plan with Prescription
    Drug Coverage authorization or notification: . Important Phone Numbers.

    Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare
    Part Include your name, phone number, and Medicare number on the MSN,
    and sign it. Note: Some IREs call themselves Part D QICs. If you disagree
    with

    OPM has determined that Humana s prescription drug coverage is, Medicare
    Part D later, you will not have to pay a penalty for late enrollment as long as you
    keep your FEHB coverage. . You need prior Plan approval for certain services .
    . Do not give your plan identification (ID) number over the telephone or to

    Medicare Services (CMS) and the Department of Medical Assistance Humana
    and Virginia Premier, have contracted to provide Medicare Part A, B, and ..
    Precertification Lookup tool online, or call Provider Services at MMP the
    request forms posted on our BH website https://provider.beaconhs.com. .
    Medicare Part D.

    plan included Part D drug coverage you may request enrollment in a prescription
    . Phone numbers and website addresses are listed in this booklet. If you have

    Oct 13, 2015 see specialists, and/or get prior authorization for certain services. Once enrolled
    in a . TRAIL prescription drug coverage, like a Medicare Part D plan, must
    follow Medicare rules for . Note: There are two Humana HMO plans, as shown
    in . Unit s address and phone number can be found on page 27.

    Medicare Prescription Drug Coverage, also called Part D or Medicare Rx, is
    available to everyone who . Are there prior authorization requirements for
    certain drugs? Plan phone numbers are listed on the following pages for your
    convenience. . Humana. Insurance. Company. (S5884). Humana Wal-Mart. Rx
    Plan (149).

    Jul 11, 2016 Re: Application for Approval of the Acquisition of Control of Humana Insurance
    Advantage, Medicare Advantage Plus and Medicare Prescription Drug Part D
    contracts (2) it receives the superintendent s prior approval.

    Use of Prior Authorization and Other Utilization Management Tools. . Prior to
    the passage of the Part D prescription drug benefit, Medicare already covered
    several requirements about the number of drugs that must be covered in each
    therapeutic class. The Thus, for example, Humana offers three different PDPs
    in.

    Apr 28, 2015 Employee must have a hire date prior to July 1, 2009. 2. Once approval for
    continuation of medical benefits has been determined, the retiree will receive a
    Retirement Medicare Part A B. The phone number is 1-800-MEDICARE.
    Humana plans manage your Medicare A, B Part D prescription

    Humana Military, a division of Phone: 1-866-773-0404 and can help TFL
    beneficiaries with prior authorizations, but do not provide referrals for TFL
    Resource Numbers. Web Sites. Medicare. 1-800-633-4227 www.medicare.gov
    . Medicare Part A may enroll in TRICARE Note: You do not need a
    Medicare Part D.

    Aug 30, 2010 and at our request, the Centers for Medicare and Medicaid Services filed
    phone number to determine their status under the plan and not recognized as
    members of the Humana Part D PDP. ances, and that the Uhms state law
    claims were therefore pre- . Toll Bridge Auth. 137 P.2d 97, 103 (Wash.

    Submit bill to party who requested testimony (e.g. attorney general 034
    Number of hours paid per agreement with L I Occupational . Requested
    records not rec d by August(AHS). . 257 Principal diagnosis code unacceptable
    according to Medicare . 319 Revenue code, cover dates or prior authorization (
    PA) number.

    toll-free number to make an appointment with a SHIBA counselor. 2016
    Coverage Gap Donut Hole in Medicare Part D 13 . Document phone calls (
    date, time, name, numbers, notes) and save Humana LI-NET (1-800-783-1307)
    will work as a . Prior authorization: The plan will not cover the drug unless your.

    Dec 24, 2015 Medicare immunization coding billing by public health . d P t D. Medicare Part
    B, Part C and Part D. Roster Billing and . Verify whether pre-authorization is
    required. https://med.noridianmedicare.com/web/jfb/forms . Are all New West,
    Sterling, and Humana plans Medicare Advantage products?

    Mar 2, 2014 It is important that you read through the instructions prior to filling out the
    application. . Phone Number: Enter the phone number that you would like
    MIDAP to use to contact you able to pick up your medications upon program
    approval. associated with Medicare Part D Prescription Plan (PDP)/Medicare

    Oct 31, 2013 Medicare program and does not change Medicare benefits or through House
    Bill 7107, creating Part IV of Chapter. 409, Florida . LLC. Humana. Medical.
    Plan, Inc. Integral. Health. Plan. Inc. d/b/a. Integral . Increasing the number of
    primary care providers that offer after hour Prior Authorization:.

    Mar 27, 2012 substantially lessened in the sale of Medicare Advantage Plans to ID H4529,
    Plan ID 27 or such other contract and plan identification number as D.
    Arcadian CMS Plans means the Amarillo Plan, Arizona Plans, Eastern . If, prior
    to complying with Section IV and V of this Final Judgment, Defendants.

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    Medicare Enrollment Centerв„ў, sell medicare supplements.#Sell #medicare #supplements


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    What’s Medicare Supplement Insurance (Medigap)?

    A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

    Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

    A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

    8 things to know about Medigap policies

    1. You must have Medicare Part A and Part B.

    2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.

    3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.

    4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.

    5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.

    6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.

    7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

    8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

    Medigap policies don’t cover everything

    Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

    Insurance plans that aren’t Medigap

    Some types of insurance aren’t Medigap plans, they include:

    • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)

    • Medicare Prescription Drug Plans

    • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)

    • Veterans’ benefits

    • Long-term care insurance policies

    • Indian Health Service, Tribal, and Urban Indian Health plans

    Dropping your entire Medigap policy (not just the drug coverage)

    If you decide to drop your entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

    If you drop your entire Medigap policy and the drug coverage wasn’t creditable prescription drug coverage or you go 63 days or more in a row before your new Medicare drug coverage begins, you have to pay a late enrollment penalty when you join a new Medicare drug plan.

    Medicare Enrollment Centerв„ў

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    “I was lost when I was turning 65. I was flooded with calls and brochures from so many different insurance companies and they all said they had the best insurnace. Thankfully, The Medicare Enrollment Centerв„ў was able to provide a comprehensive comparison of all the different insurance companies available in my area which helped my decision making process very simple. Glad I called. Thanks guys!”

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    “The Medicare Enrollment Centerв„ў has been wonderful in helping my husband and I transition into Medicare. We trust our agent and know he treats us with the highest level of inegrity and care.”

    What Is Medicare

    Medicare is a federal program, managed by the Centers for Medicare & Medicaid Services. It provides health insurance to eligible United States citizens and permanent residents of five or more years. You’re eligible for Medicare if you’re 65 or older, or under 65 with certain disabilities. You may also qualify for Medicare, regardless of age, if you have end-stage renal disease requiring dialysis or a kidney transplant, or amyotrophic lateral sclerosis (also known as Lou Gehrig’s Disease).

    Medicare Supplement (Medigap) Insurance

    A Medigap policy is health insurance sold by private insurancecompanies to fill gaps in Original Medicare coverage. Medigap policies can help pay your share (like coinsurance, copayments, or deductibles) of the costs of Medicare‑covered services.

    Medicare Part C (Medicare Advantage Plans)

    Medicare Advantage plans are sometimes referred to as Medicare Part C. They are Medicare-approved private health insurance plans for individuals enrolled in Original Medicare, Part A and Part B. When you join a Medicare Advantage plan, you are still in the Medicare program and must continue paying your Part B premium.

    Dental, Vision, and Hearing Plans

    Many seniors pay large out of pocket expenses for specialized care by optometrists, ophthalmologists, and audiologists, and even for routine care by their local dentists. Other seniors have depended on costly health plans to help cover these costs—often wondering whether the high costs of their plans were indeed worth the coverage the plans provided.

    What is Final Expense Insurance?

    A Medigap policy is health insurance sold by private insurancecompanies to fill gaps in Original Medicare coverage. Medigap policies can help pay your share (like coinsurance, copayments, or deductibles) of the costs of Medicare‑covered services.Final expense insurance is an insurance policy used to pay for burial expenses and funeral services when the named insured dies. Such a policy helps ease the financial burden placed on a family when a loved one dies.

    ​ Final Expense insurance is a basic issue life insurance policy that covers people until they reach 100 years old. It is quite similar to universal life insurance and is sometimes referred to as graded life or burial insurance with easy issue permanent coverage.

    As an inexpensive insurance choice, final expense coverage can be used to cover the funeral and burial costs of the policy holder. Most people who do not want to place a hardship or burden their families with these burial and funeral costs will take out burial insurance polices.


  • Medicare Benefit for Hospice Care – New York State #hospice #stories

    #medicare hospice benefit

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    Hospice

    Hospice provides appropriate skilled, compassionate care to patients and their families so that they receive the support, help and guidance they need to meet the challenges of serious illness. A personalized plan of care incorporating what is important to the patient and the caregiver is developed. It is sensitive to their needs and emphasizes quality of life, and assists patients to live as fully and comfortably as possible. The philosophy of care called hospice has been practiced in New York State for more than two decades.

    Hospice:

    • Embraces all patients coping with advanced illnesses
    • Focuses on comfort rather than cure
    • Emphasizes quality of life
    • Promotes personal choice and individual dignity
    • Respects the traditions and wishes of the patient and the patient s family
    • Most often provides care in the patient s home, but when necessary, can also provide care in a nursing home and inpatient setting
    • Utilizes current treatments and medications
    • Addresses physical, social, emotional, and spiritual needs
    • Provides care and support to the bereaved

    Hospice Medicare Benefit

    Coping with a terminal illness can be a difficult enough experience without having to worry about pain management, medication costs, and assistance with caregiving. Surprisingly, many Medicare beneficiaries are unaware that Medicare s all-inclusive Hospice Benefit is available to assist dying patients and their families with these issues at the end of life. Hospice care offers a team-oriented approach to medical care, pain management, and emotional and spiritual support tailored to the dying patient s needs and wishes. For patients who qualify, Medicare will pay for this kind of comprehensive end-of-life care delivered at home or in a hospice facility. The Medicare benefit includes many services not generally covered by Medicare and more than 90 percent of the more than 2,500 hospices in the United States are certified by Medicare.

    Medicare Hospice Benefit Information

    Choosing hospice care is a difficult decision. The information in this booklet and support from a doctor and trained hospice care team can help you choose the most appropriate health care options for someone who’s terminally ill. This official government booklet for Medicare hospice benefits includes information about:

    • Who is eligible for Hospice care
    • What services are included
    • How to find a Hospice program
    • Where to get more information.

    Section Guide





    Medicare Hospice Benefit – Lower Cape Fear Hospice #discount #travel

    #medicare hospice benefit

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    Medicare Hospice Benefit

    The Medicare Hospice Benefit stipulates that we have contracts with physicians who provide services to hospice patients. Physicians often fall into both of the following contract categories for a variety of patients.

    • Refers and attends to the patient on hospice services
    • Verbally certifies prognosis of six months or less should the disease run its expected course
    • Signs and returns the initial plan of care within 48 hours of admission to initiate case management and ensure prompt payment
    • Bill Medicare Part B with GV modifier for administrative services pertaining to the hospice diagnosis
    • Bill Medicare Part B for care plan oversight using CPT code 99377
    • Procedures designated by the appropriate CPT-4 code are billed directly to Medicare Part B
    • Designate an alternate physician when you are unavailable
    • All physicians other than the attending physicians
    • Services related to the hospice diagnosis are billed to LCFH on form HCFA 1500. Services are reimbursed at 100% Medicare allowable
    • Services unrelated to the terminal illness can be billed directly to Medicare Part B with modifier GW
    • One contract may be used for a group of physicians as long as they are listed on attachment A of contract agreement

    We are not your typical hospice agency. The philosophy of our care is centered around patient and family goals. Palliative therapies recommended to alleviate symptoms or improve quality of life are encouraged and may include:

    • Thoracentesis/paracentesis to be done in the ER or radiology department
    • Blood transfusions or products such as Procrit
    • Chemotherapy and radiation therapy for pain/symptom management
    • PT/OT/ST evaluations and treatment
    • Lab/diagnostic studies and medications outside of our medication list

    All therapies are evaluated for appropriateness based on the evidence of efficacy, burdens verses benefit and informed consent of the patient. That is why we request that you inform Lower Cape Fear Hospice when referring patients to other physicians or facilities as this may affect the overall plan of care and administration of the Medicare Hospice Benefit.

    Our physician staff members specialize in symptom management and are available to you for consultation, 24/7. Together they work with the team of caregivers to be vigilant of changes so your patient s needs are addressed quickly. One way this is accomplished is after a nursing assessment and likely symptoms are expected, you, the physician may be suggested to order a comfort kit. This contains medications for immediate symptom management of:

    • Pain and dyspnea due to COPD/Cancer or CHF
    • Anxiety, agitation or restlessness
    • Nausea, vomiting or excessive secretions

    Having these medicines readily available to the patient has prevented many early morning calls to your office and unnecessary trips to the ER for symptom management.

    If you have questions, please call us at 800.207.6908. We look forward to serving you and your patients.

    Do You Need Help?

    Hospice care is a benefit covered by Medicare, Medicaid and most private insurances. To find out if you or someone you love qualifies for our services, call 1-800-207-6908.





    Primary Care Doctor Shortage – How Does the Health Care Law Address


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    Javascript is not enabled.

    How to Beat the Doctor Shortage

    En español l For years, Marcia Andrews visited the same internist in Washington, D.C. Then she turned 65, got her Medicare card and had to find a new doctor: Her internist was not accepting Medicare patients. Primary care doctors are in such demand now that they can choose not to accept Medicare, whose reimbursements to physicians are lower than private insurance rates.

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    More and more people, especially Medicare patients, are having trouble finding a doctor.

    The doctor shortage is worse than most people think, says Steven Berk, M.D. dean of the School of Medicine at Texas Tech University. The population is getting older, so there’s a greater need for primary care physicians. At the same time, physicians are getting older, too, and they’re retiring earlier, Berk says. And graying doctors — nearly half the nation’s 830,000 physicians are over age 50 — are seeing fewer patients than they did four years ago, a 2012 Physicians Foundation survey reported.

    Soon, this fraying primary care network will face another huge challenge: Under the Affordable Care Act. millions of formerly uninsured men and women will have access to health care.

    We need to absorb these 30 million people, and that’s going to be a strain, says Russell Phillips, M.D. director of Harvard Medical School’s new Center for Primary Care.

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    A fundamental change

    The approach most favored by experts at Harvard and elsewhere is to reshape traditional primary care: from a stream of patients waiting to see one harried doctor to a more efficient team practice in which patients with routine problems are seen by nurse-practitioners and physician assistants — trained specialists with master’s degrees. The team frees the doctor to spend more time with patients with more serious complaints.This change could be as fundamental as the one that took place when most family doctors stopped making Marcus Welby-like house calls.

    The Affordable Care Act encourages such a sea change, with provisions that aim to shore up and expand the country’s ailing primary care system while still reducing costs.

    The ACA authorizes money to increase the primary care workforce by training more doctors, nurses, nurse-practitioners and physician assistants. It includes more graduate medical education training positions, with priorities for primary care and general surgery, and more money for scholarships and loans for all health professionals. The law expands the number of patients seen at community health centers in areas with too few doctors and increases the number of staffers who work in the centers. It also expands nurse-managed clinics at nursing schools where nurses in training see patients who live in the area.

    Another key provision: a 10 percent bonus, through 2015, to primary care doctors who offer services to Medicare patients.

    But in these times of shrinking federal budgets, it’s unclear how much ACA primary care money will be available as Congress juggles competing priorities. Congress, for example, already has chopped about $6.25 billion from the ACA’s new $15 billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts catastrophic.

    A recent study by the Institute of Medicine and the National Research Council reports that, when compared with citizens of 16 other high-income democracies, including those of Western Europe, Japan and Canada, Americans not only die younger but have poorer overall health. The researchers traced U.S. health disadvantages to a number of causes, including the fact that Americans have more limited access to primary care.

    Where have all the doctors gone?

    Today, the United States is short about 16,000 primary care doctors — the very doctors (family practitioners, internists and pediatricians) who offer the treatments and preventive screenings that save lives and head off expensive emergency room visits and hospitalizations.

    Why the shortage? It starts with huge medical school debts and ends with a doctor who is often overworked and underpaid. While students may enter medical school wanting to practice primary care medicine, they graduate saddled with heavy debt — $250,000 is not unusual — which prompts them to switch to a more lucrative specialty. The starting salary for a primary care physician is $150,000 to $170,000; a radiologist or gastroenterologist can make two to three times that.

    Only one in five graduating internal medicine residents plans to go into primary care medicine, the Journal of the American Medical Association reports.

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    Looking for a Doctor?

    The best place to start is your state medical association. Many provide doctor directories that often include new doctors just setting up practice.

    If you’re a Medicare beneficiary, go to medicare.gov . Under Forms, Help and Resources on the home page, select Find doctors, hospitals and facilities. Type in your ZIP code and you’ll get a drop-down menu of medical specialties, including primary care. The tool provides contact information for doctors according to the criteria you enter — geographic location, specialty, etc. Call the office to check whether the doctor is still taking new patients.

    Clay Buchanan, a former lawyer, is one of those graduating in May. At 48, the Little Rock, Ark. resident is older than most medical students. He shadowed a family doctor as part of his training — and was hooked. By noon the first day, I loved it, Buchanan says.

    New York University and several other colleges are planning to experiment with a three-year program.

    Health clinics offer primary care

    Community health centers offer another form of primary care. Nationwide, the centers serve 20 million patients a year using a team approach, and are open to all on a sliding fee scale. Under the ACA, they are expected to double their capacity to 40 million patients by 2015. To entice doctors to work at these centers, the National Health Service Corps repays up to $120,000 in loans for each doctor in return for four years’ service.

    Technology, including telemedicine — which could reduce patient trips to the doctor’s office — also should help expand health care.

    Another way to increase health services is to give physician extenders — nurses and other medical professionals — more autonomy. Patricia Grady, director of the National Institute of Nursing Research at the National Institutes of Health, supports increasing the role of trained nurses, allowing them to set up independent practices where they could do physical exams and advise patients on exercise and diet.

    But that position has met with some resistance. The American Academy of Family Physicians and the American Medical Association (AMA) favor training more physicians and nurses but want to keep nurses in teams led by doctors.

    Nurses and foreign doctors

    Permitting more foreign doctors to practice here also would increase the pool of primary care providers. Last fall, President Obama signed a three-year extension of a visa waiver program that allows states to place 30 foreign medical school graduates a year in medically underserved areas for three years. Most remain in the communities after they satisfy their commitment. Still, the shortage is so acute, even the AMA is lobbying Congress to increase to 50 the number of foreign-educated doctors each state is allowed.

    In the meantime, more Americans are anxiously searching for a primary care doctor — or waiting months to see one. Marcia Andrews, whose Washington doctor refused to take Medicare, finally found a new doctor who does. The search took her 18 months.

    Marsha Mercer is a freelance journalist who lives in the Washington, D.C. area.

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    Thank You

    Thank you for your interest
    in volunteering!


    Nurse coder, American Association of Clinical Coders & Auditors Home #nurse #coder,


    #

    The AACCA Board of Directors are forecasting having the new combined AACCA RN-Coder certification exam ready before the end of August 2017.

    The AACCA members in the previous RN-Coder programs have until December. 31st, 2017 to complete their programs take their AACCA certification exams. After that date, the AACCA exams as RN-Coder Basic, RN-Coder ICD10

    RN-Auditor (with ICD9) will not be available.

    So the new Certified RN-Coder credential will test everyone over ICD10CM, ICD10PCS, CPT, and HCPCS. 300 questions in 4 sections, 75 multiple choice questions each. These are timed, 3 hours per section. There will no longer be a separate RN-Coder ICD10 certification exam or credential.

    When you notify the RN-Coder website that you are ready for the AACCA RN-Coder exam (we check to be sure you’ve already taken the RN-Coder final exam within the online learning environment) — we send you the 4 links to the AACCA RN-Coder certification.

    The $299 cost of the AACCA certification exam is included in your RN-Coder STAT program package. You DO have to join AACCA ($199 year) to take their exams. AND to maintain your AACCA credentials, you have to turn in 40 CE contact hours related to coding documentation compliance (not nursng) every 2 years (not per credential) and maintain your membership in good standing.

    Most of our members use their RN-Coder/

    RN-Auditor CE certificate of completion.

    As for RN-Auditor — same thing with that AACCA exam — when the new program is ready, the certification will take about 2-3 months to update.

    Same thing for RN-CDS. For this one Board of Directors have been vacillating between RN-Clinical Documentation Specialist or

    RN-Coder Documentation Specialist . The program is finished — about 6 Certified RN-Coders with ICD10 certification and current CDI work experience helped Dr. Allison Mattila I work on it — just waiting for that new textbook updated with ICD10 from the AMA in September!

    Hope that helps answer your questions about the AACCA credentialling process going forward this year.

    — Joyce Thomas, MHA, CCC- Advanced

    FoundingBoard of Directors

    In 2003 a group of Masters-prepared Registered Nurses, a PhD RN from a state licensing board, a Nurse JD, 2 physicians (who received the first “Certified MD-Coder” credentials, and a Physicians Assistant decided to form a group which would provide valid testing of clinical personnel’s knowledge of correct coding, compliance in coding and documentation, and fraud and abuse issues. At the time the only group which would admit nurses for testing had announced it was “up for sale.”

    Fearful of forfeiting their test fees, and what would “that” credential mean, the RNs decided they could launch their own group! After all, many had advanced degrees, most had been in management, and the Founding Board of Directors agreed to serve for the first 3 years, which became 5 years.

    The American Association of Clinical Coders and Auditors was born, with a nurse attorney from Houston helped set up the organization’s legal status, and we set to work to develop our test bank of multiple-choice questions, determined what’s passing, and all took the tests several times for validity and Qa with the appropriate coding manual.

    To date, AACCA has over 4000 members and has tested/credentialed 3682 members, 99%
    Registered Nurses. Our goal for the next year is to double our membership and the number of credentialed RN-Coders and RN-Auditors.

    One of the best innovations in coding testing: AACCA is still the only organization providing computer-based online testing and immediate test results.

    In 2012, AACCA hit another milestone: It became the first organization offer RNs the ICD10 certification examination and credential: Certified RN-Coder 10.

    We want to thank Hilary Falconer, Jennifer Woodruff, Gayla Crouch, Patricia Spurr, Sondra Strand, Linda Drummond for having the knowledge, strength — and guts to stand up and say, “I’m in!”

    Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead

    The National Voice of

    Certified RN-Coders and Certified RN-Auditors.

    AACCA provides resources and support to advance the practice of Registered Nurses, physicians and other clinical personnel performing coding of and review of medical documentation in a changing healthcare reporting and reimbursement system.


    Cadabams offers best alcohol drug rehab centers, psychiatric rehabilitation care #mental #rehab


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    ABOUT. Cadabams Rehabilitation Centre

    Access to Quality mental health care, the Vision in mind and passion to work for persons with mental health problems and shoulder the care and responsibility with family is what made Mr Cadabam M Ramesh and Mrs Sudha R Cadabam to establish an organisation to serve persons with mental health problems. As sequel to quality care offered and commitment for betterment of persons with mental health problems CADABAM’S today has evolved into country’s largest psycho social rehabilitation centre with various specialty offerings.

    PSYCHO. Social Rehabilitation Centres

    • I had PhD and doing well in USA till I was stuck by Schizophrenia which lopsided my life bringing me to streets and finally to CADABAM’S as last option. After 2 years of rehabilitation at CADABAM’S I back on track with a job and proudly talk about my journey.
    • We as family were in shambles when we approached CADABAM’S as our only son has full blown psychosis. Just few months and right medication and psycho social care, we see a different person all together and thank CADABAM’S for being so kind to us and giving our son back.
    • I thank CADABAM’S who have really given me a new life. From being beaten by my husband and taking care of whole family and children he is back as a very responsible person understanding his responsibilities and quitting his habits completely.
    • It was a nightmare worrying about my mother who had depression and was all alone in India while I was in UK with my work and family. Its almost 2 years now that she is at CADABAM’S being very happy and taken care. I thank whole CADABAM’S Team for giving my mother a new life.
    • It was a rude shock to find our son with GANJA abuse and alcohol intake. Though there was gradual change in his behaviour we never could understand that it was because of his habbits. Just few months of treatment and support of counsellors and good medication he is back to studies and doing well. I thank doctors and counsellors for all the help and support.

    CADABAM’S Group

    Gulakamale Village, Near Kaggalipura,
    17th Mile Kanakapura Road,
    Post Taralu,
    Bangalore-560082.


    Center Drug Co – Geneva AL near 702 W Maple Ave, 702


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    Center Drug Co

    Overview

    Center Drug Co is a local retailer of Wiregrass Drugs, Inc, its parent company, in Geneva, Alabama. Center Drug Co sells a total of 22 Medicare chargeable items at 702 W Maple Ave, Geneva, AL 36340. However Center Drug Co do not accept Medicare as payment You should contact Center Drug Co by phone: (334) 684-0453 for more detail about medical equipment, supplies and Medicare payment they offered.

    Address: 702 W Maple Ave
    Geneva, Alabama 36340

    Map and Directions

    Customer Support Phone

    • Accept Medicare Assignment: The supplier always accepts assignment for the category, which means they accept the Medicare-approved amount as payment in full for all claims for the category. You may pay more for equipment and supplies from suppliers that don’t accept Medicare’s approved payment amount as payment in full. You should ask the supplier if it will accept the Medicare-approved amount as payment in full for your item.
    • Competitive Bid Service Area: The intent of the Competitive Bidding Program is to ensure beneficiary access to quality items and services while reducing out-of-pocket expenses by awarding Medicare contracts only to local suppliers with the most competitive bid prices. Generally, if you want Medicare to help pay for Competitive Bidding Program equipment or supplies, you’ll need to get the equipment or supplies from a supplier which participating the Competitive Bidding Program.

    Contact Information

    • Address: 702 W Maple Ave, Geneva, Alabama 36340
    • Phone: (334) 684-0453
    • Office Hours:
      • Monday: 8:00 AM – 5:00 PM
      • Tuesday: 8:00 AM – 5:00 PM
      • Wednesday: 8:00 AM – 5:00 PM
      • Thursday: 8:00 AM – 5:00 PM
      • Friday: 8:00 AM – 5:00 PM
      • Saturday: Closed
      • Sunday: Closed

    Medicare Supplies

    Disclaimer. HealthCare6.com doesn’t endorse any products. The information in this directory comes directly from Medicare database. HealthCare6.com doesn’t edit this information and hasn’t checked the products to verify if they meet Medicare’s rules. You must meet all coverage rules for Medicare to help pay for any item.

    Center Drug Co carries the following product category(s) near 36340

    Blood Glucose Monitors & Supplies: Non-Mail Order

    Breast Prostheses & Accessories

    Commodes, Urinals, & Bedpans

    CPAP, RADs, & Related Supplies & Accessories

    Diabetic Shoes & Inserts: Prefabricated

    Hospital Beds: Electric

    Hospital Beds: Manual

    Nebulizer Equipment & Supplies

    Oxygen Equipment & Supplies

    Power Operated Vehicles (Scooters)

    Seat Lift Mechanisms

    Support Surfaces: Pressure Reducing Beds, Mattresses, Overlays, & Pads

    Wheelchairs & Accessories: Standard Manual

    Wheelchairs & Accessories: Standard Power

    This supplier information was updated by using data source from Centers for Medicare and Medicaid Services (CMS) which is publicized on Friday, July 24, 2015. If you found out that something incorrect and want to change it, please follow this Update Data guide.

    Call Center Drug Co by phone: (334) 684-0453 for more detailed description about medical equipment, drugs, supplies they offered and also discuss with them about insurance, Medicare questions and medical supply needs before going to them.

    See more related providers

    Reviews

    Center Drug Co Local retailer of Wiregrass Drugs, Inc in Geneva, Alabama


    Medicare Supplement Insurance & Medicare Advantage Personal Service #medicare #gap


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    Medicare Supplement Insurance

    Medigap Insurance Coverage, Made Simple

    At MediGap Advisors. it’s our mission to make sense out of the complicated system of Medicare and Medicare supplement insurance. We focus on breaking everything down into easy-to-manage steps so your options are clear and your choices are simple.

    When you take advantage of our system, you’ll find the process of shopping for Medicare supplement insurance, a Medicare Advantage plan, or a Part D prescription drug plan to be easy and hassle-free. You can compare numerous plans for Medigap coverage here on our website, or contact us directly and let us know how we can assist. To get started, you can either check your rates online or give us a call at 800-913-3416 to let us answer your questions and help you choose the right plan.

    Medicare Supplement Insurance, also known as MediGap Insurance. is designed to help cover some of the medical costs that are not covered by Medicare. These Medigap coverage plans are available to anyone enrolled in Part A and B of Medicare. There is an open MediGap Insurance enrollment period for the first six months after you turn age 65, in which you do not need to qualify or answer any questions about your prior medical history.

    We are a team of dedicated friendly Medigap personal benefits consultants, and we are here to answer your questions and help you choose a Medicare supplement insurance plan.

    Give us a call toll-free at 800-913-3416

    We also invite you to listen to our Telephone Webinars. With many years of experience, our MediGap insurance experts can tell you how to get the most from Medicare. They can answer 90% of your questions during the Webinar, and you’ll also have the opportunity to ask questions during the open Question Answer Session.

    Save Money on your Medicare Supplement Plan

    At MediGap Advisors. we believe it is our duty to help you save money on your Medicare supplementation plan, and to make the purchase EASY, and hassle-free. You’ll not only find the best Medigap plan for your needs now, but you’ll also have access to a Personal Benefits Consultant any time you have questions about your Medicare supplemental needs.

    More Information from our Medigap Advisor Blog

    What our clients are saying:

    “Dawn worked with me to provide the coverage I needed. I received a ton of advertisements from all the companies in this field and I must admit that it is very confusing and stressful. But with Dawn, she made the whole process of obtaining coverage easy by explaining each and every step.”

    Walter Straight – Denver, CO

    “I had an excellent shopping and purchasing experience with MediGap Advisors. As a personal benefits consultant, Leslie is prompt, professional and knowledgeable. I found her extremely helpful as I made my insurance decisions. Leslie simply did a great job for me and your company.”

    Patrick Michaels – Richardson, TX

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    2016 – All Rights Reserved
    Disclaimer: Medigap Advisors is not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare has neither reviewed nor endorsed the information contained on this website. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week.


    Health Care Information System (HCIS) Data File – Centers for Medicare &

    #health care information

    #

    Health Care Information System (HCIS) Data File

    ALERT: Data Files for 2009 – 2011 are now available as free downloads. See the Downloads section below. A read-me file is included in the zipped file. Some of the Tables are inCSV (Comma Separated Values) format: A data format in which each piece of data is separated by a comma. This is a popular format for transferring data from one application to another, because most database and spreadsheet systems are able to import and export comma-delimited data. CSV files can be opened by the majority of spreadsheet and database programs available. If opened in Excel, column widths will have to be adjusted.

    The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A B) and Hospice) and Medicare Part B (Outpatient) based on the type and State of the institutional provider. Data in HCIS is summarized from the Standard Analytical Files.

    The data set names correspond with the provider type. Brief descriptions of the provider types and the selected reporting elements are provided in the read-me file.

    Data Format: CSV and Microsoft Excel

    Approximate Size: 5.22 MB zipped

    Compatible Software Programs: Microsoft Excel, Microsoft Access, Microsoft SQL/DB2/Oracle, SAS or other statistical software.

    Media: CD ROM
    File Cost: $100.00 per year
    Available: CY 2000 through 2011 (2009 – 2011 are available as a free downloads below)

    Downloads

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    Home hospice care medicare #motel #stari #hrast

    #home hospice care medicare

    #

    Compassion. Integrity. Excellence.

    Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

    At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

    Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

    Families

    Every patient is a unique story.
    Read more.


  • Healthcare Professionals

    We support our referring physicians.
    Find out how.


  • Volunteers and donors

    Make a difference in someone s life.
    Become a volunteer today.
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  • SNF – Hospice Contracts Under the New Hospice Medicare Conditions of Participation

    #hospice cops

    #

    SNF – Hospice Contracts Under the New Hospice Medicare Conditions of Participation

    Sunday, August 23, 2009

    Our article in the December 2008 issue of Shorts on Long Term Care, about CMS’s revised hospice Medicare Conditions of Participation (CoPs) and their impact on the existing contracts that nursing homes may have with hospice agencies, generated some questions. Here are some of the questions we’ve heard and the answers:

    Q: Do the new CoPs apply only to hospices or also to the SNF, where the SNF has a contract with a hospice agency to provide hospice care to a resident of the facility?
    A: This question came from an SNF provider that expressed concern over some of the new language it was seeing in revised contracts sent by the hospice to be executed. The gist of the question was “if we choose not to accept the revised contracts, what happens?” Technically, these new CoPs apply to the hospice, not to the SNF. However, the new CoPs are very specific about issues that must be addressed in any SNFhospice contract (see our December 2008 article for details). So the hospice is required to include these new provisions in all their contracts with SNFs, and those requirements do impose some additional burdens on the nursing home as well as the hospice. For example, both parties must coordinate their care of a hospice SNF resident more closely, with specific documentation of how they plan to do this. There are other areas where the SNF will have to work closely with the hospice to meet the new CoPs. Because the hospice is required to meet the new CoPs, including the contract requirements, if an SNF refuses to enter into a new agreement with a hospice that complies with the new CoPs, that hospice would be within its rights to cancel any existing agreement and discontinue services. In addition, since nursing homes are required under state and federal law to provide care that is appropriate for and needed by a resident, a refusal to treat hospice patients consistent with the new CoPs could be a basis for deficiency citations against the nursing home. So, if they plan to continue offering hospice in the nursing facility, both parties need to find language they can live with that also complies with the new CoPs.

    Q: If my nursing home already has a contract with our hospice agency that is not scheduled to expire or be renewed at this time, are we still required to enter into a new agreement with the hospice now, or can we wait until our current contract term ends?
    A: Generally, you are not required to execute a new contract with an entity with which you already have an existing, ongoing agreement. However, most contracts contain language stating that if the existing contract is inconsistent with applicable law, the parties agree to negotiate in good faith to revise the contract to remedy any such noncompliance. Given the fairly extensive changes made by the new hospice CoPs to various types of contracts, hospice agencies have a pretty good argument that the contracts they had in place under the old regulations probably are not totally compliant with the revised CoPs. As a result, those agencies will need either to amend those contracts to meet the new CoPs, replace them entirely (which many hospices are opting to do, given the scope of changes required by the new CoPs) or terminate the services they were offering under the old agreement. Continuing to use contracts that are not fully compliant with the CoPs puts hospices at risk for deficiency citations, potential loss of payment and, at least in theory, loss of Medicare certification.

    Q: When should my new or amended contract with my hospice agency be in place?
    A: Technically, the effective date of the new CoPs was December 2, 2008. So, ideally, those revised contracts should already be executed by both parties and in place. Realistically, we don’t expect state surveyors to be out checking the detailed language of providers’ contracts right away, since the providers are still getting used to the new CoPs themselves. However, we have been told that if a complaint by a patient, family member or staff member leads the survey team to a contract as part of the problem, it’s fair game for the team members to request and review all contracts in detail, if they choose. Also, hospice surveyors are directed to request a list of certain hospice contracts during the survey entrance conference, so they can easily request copies as well, if they choose.

    © 2009 Poyner Spruill LLP. All rights reserved

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    Hospice Experience of Care Survey – Centers for Medicare & Medicaid Services

    #hospice ratings

    #

    Hospice Experience of Care Survey

    Overview. The CAHPS® Hospice Survey gathers information on the experiences of hospice patients and their informal caregivers’ perspectives of their loved ones’ care with hospice services. Current trends are toward increased use of hospice services in the U.S. More than a million Americans are receiving hospice services annually. The Hospice CAHPS® Survey started national implementation in January 2015.

    About the survey. The Hospice CAHPS® Survey samples the primary caregivers of deceased hospice patients who meet survey criteria. Survey administration will occur several months after the death. The survey includes the following key topics: starting hospice care; help for the patients’ symptoms, communication with the hospice team, caregivers’ own experiences with hospice care services; an overall rating of hospice care, and a question about willingness to recommend the hospice. There are three approved modes of survey administration: mail only, telephone only, and mixed (mail followed by telephone).

    Policy relevance. The Hospice CAHPS® Survey is required for the FY 2017 Annual Payment Update (APU) determination and subsequent FY APU periods. Implementation started with a dry run for at least 1 month in the first quarter of CY 2015 (January 2015, February 2015, and/or March 2015) plus 3 quarters of continuous monthly participation (April 1, 2015 through December 31, 2015). Monthly participation is required for all subsequent months.

    For more information, please visit the Hospice CAHPS® Survey web site at: http://www.hospicecahpssurvey.org .

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    Feds sue Hospice of the Comforter: Federal government sues Hospice of the

    #hospice of the comforter

    #

    Feds sue Hospice of the Comforter for Medicare fraud

    January 14, 2013 | By Kate Santich, Orlando Sentinel

    The federal government is suing Hospice of the Comforter for Medicare fraud, alleging that since at least 2005 the Altamonte Springs-based nonprofit knowingly billed for patients who were not terminally ill and even encouraged “creative” record-keeping to cover up the truth.

    The facility could face millions of dollars in fines and damages as a result.

    The suit, filed late last week by the U.S. Attorney’s Office, cites a case where the facility allegedly billed for hospice care over 4 1/2 years for an Alzheimer’s patient who was never considered terminally ill. Typically patients move to hospice care when they have less than six months to live.

    In another case, when a nurse noted that a patient’s current condition would not qualify for hospice care, the diagnosis was suddenly changed to rectal cancer, the suit says, though there was no evidence the patient had cancer at any point during her 287-day stay in hospice.

    At charges averaging more than $4,000 a month, bills for the two patients added up to more than $180,000 from Medicare the taxpayer-funded health-insurance program for the elderly and disabled.

    The suit specifically alleges that longtime hospice CEO Robert Wilson instructed employees to admit patients without determining whether they were terminally ill, as Medicare requires, and then to bill the federal program for reimbursement. Staff also was instructed to find ways to document the cases in patients’ medical files so that the billings appeared legitimate.

    Latour “LT” Lafferty, a Tampa attorney representing Hospice of the Comforter, said the charity “vehemently denies” that there was ever any intent to defraud the government. He also said management has been fully cooperative with the investigation and is trying to resolve the matter.

    “What I can tell you is that Bob [Robert Wilson] has always been and is fully committed to providing the highest quality of care to his patients, regardless of whether or not they’re reimbursed by the federal government,” Lafferty said. “So if a person comes to Hospice of the Comforter seeking care, Bob will be the first person to give it to them, regardless of payment.”

    Federal tax records show that Wilson made large bonuses based on how many patients were under hospice care each day.

    Tax returns filed with the Internal Revenue Service for 2009, for instance, show that Wilson earned a base salary of $122,000, plus patient bonuses of nearly $207,000 for the year. That did not include retirement pay and other deferred compensation, including a clergy-housing allowance, that brought his total to more than $362,000. Wilson is a chaplain.

    The latest allegations echo charges first made in October 2011 by a former hospice executive, who said he tried to get the hospice management to “do the right thing” by acknowledging improper Medicare billings and repaying the money.

    When that effort failed, former vice president of finance Douglas Stone said, he was fired by Hospice of the Comforter. Stone filed his own federal whistleblower case but agreed in August to let the Department of Justice pursue the matter instead.

    “I am pleased that after a more than yearlong investigation the Justice Department complaint describes in detail exactly what was alleged” in his own lawsuit, Stone said. “The Hospice of the Comforter Board of Directors had ample opportunity to do the right thing, follow the law, and return overpayments. Instead they allowed retaliation against a number of individuals making good faith efforts to report potential fraud.”

    Wilson, who co-founded the hospice in 1990 and helped establish its well-regarded reputation in the community, referred a request for his comments to Lafferty. The attorney said Wilson is no longer CEO at Hospice of the Comforter, but he remains its president as well as chairman of the Comforter Health Care Group Board of Directors, the hospice’s parent company.

    Although patients can and often do stay under hospice care for longer than the six-month guideline, a physician must periodically recertify the patient as terminally ill.

    But at Hospice of the Comforter, the suit says, if a review committee recommended that a patient be discharged, the hospice would order more tests to delay the discharge and continue billing Medicare.

    Wilson also had a list of patients whom nurses referred to in notes as FOBs, or “friends of Bob” who were not to be discharged regardless of what reviewers found, the suit says.

    The total amount of actual damages, the government said, would have to be determined at trial, but the law allows the court to fine hospice as much as triple that amount.

    Since May, Hospice of the Comforter has operated under a management agreement with Adventist Health System, the parent company of Florida Hospital chain, which reportedly had been interested in buying the facility at one point.

    Spokeswoman Samantha O’Lenick would not comment on the lawsuit, noting that Adventist Health’s contract with the hospice went into effect after the whistleblower lawsuit was filed and so is not involved.





    MN Insurance Agent Minnesota Auto Car Homeowners Life Health Quote Columbia Heights


    #

    McAlpin Agency, Inc.

    Our Mission

    As an Independent Insurance Agency, it is our goal to provide you with the best coverage at the lowest price from a top quality company.

    To request a quote for MN insurance, click on the Quotes link above.
    Then choose the line of insurance from the Quote Forms menu that will appear.

    There are quote forms for Auto / Car, Homeowners, Health, Medicare Supplements, Medicare Advantage Plans, Medicare Part D Prescription Drug Plans, Life, Dental, Long-Term Care, Disability Income, Global / Travel Medical insurance, Employee Benefits, Commercial, Motorcycle, Watercraft (boats), Jet Ski (personal watercraft) Snowmobile.

    At McAlpin Agency, Inc. we are committed to protecting your privacy as a visitor to this Web site and as our customer. To our visitors and to our customers, we offer this pledge:

    McAlpin Agency, Inc. is the owner of the information, which is collected on this Web site. We will not sell, disseminate, disclose, trade, transmit, transfer, share, lease or rent any personally identifiable information to any third party not specifically authorized by you to receive your information except as we have disclosed to you in this Privacy Policy.

    Information Collection
    We will ask you to provide your personal information to us when you enroll for coverage and when you purchase an insurance policy from us. We will also ask you to provide your personal information to us when you send e-mail to us from this Web site. When you enroll for an insurance policy at McAlpin Agency, Inc. we will ask you to provide your name, home address, mailing address, telephone number and e-mail address. This information will be provided to the insurance company when you purchase an insurance policy so they can establish you as a policyholder. We will maintain a record of your information at the offices of McAlpin Agency, Inc. so we can provide you with policyholder service. The employees of McAlpin Agency, Inc. are each required to sign and acknowledge a Confidentiality And Nondisclosure Agreement. Each employee has been instructed on maintaining the privacy of each customer and the importance of protecting the customer’s personal information.
    When you purchase an insurance policy from McAlpin Agency, Inc. you will pay the premiums with your credit card or personal check. If you use your credit card to pay the premium, your credit card information is deleted from our records after your purchase has been authorized. A transaction number will be provided to you on your Binder Of Insurance. You may use this transaction number as a reference to the credit card purchase. We do not keep a record of your credit card information. If you pay the premium using your personal check, we will keep a copy of your check in your file.

    When you send us e-mail from this Web site, you will provide us with certain personally identifiable information including your e-mail address.

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    This Web site may contain links to third party Web sites that are not controlled by McAlpin Agency, Inc. These third party links are made available to you as a convenience and you agree to use these links at your own risk. Please be aware that McAlpin Agency, Inc. is not responsible for the content of third party Web sites linked to YOUR AGENCY NAME nor are we responsible for the privacy policy or practices of third party Web sites linked to McAlpin Agency, Inc. Our Privacy Policy only applies to information we collect from you while you are at and while you are actively in a session with McAlpin Agency, Inc. If you should link to a third party Web site from McAlpin Agency, Inc. we strongly encourage you to review and become familiar with that Web site’s privacy policy.

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    If you have any questions about our privacy policy, please feel free to contact us at:

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    Personal Lines Insurance


    Hospice medicare #weekly #rates #motels

    #hospice medicare

    #

    Compassion. Integrity. Excellence.

    Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

    At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

    Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

    Families

    Every patient is a unique story.
    Read more.


  • Healthcare Professionals

    We support our referring physicians.
    Find out how.


  • Volunteers and donors

    Make a difference in someone s life.
    Become a volunteer today.
    Learn how.





  • Medicare Advantage Plans cover all Medicare services #womens #clothes

    #hospice advantage

    #

    Medicare Advantage Plans cover all Medicare services

    Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgently needed care .

    The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

    Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.

    In 2016, most people pay the Part B premium of $104.90 each month.

    If you need a service that the plan says isn’t medically necessary, you may have to pay all the costs of the service, but you have the right to appeal the decision.

    You can also ask the plan for a written advance coverage decision to make sure a service is medically necessary and will be covered. If the plan won’t pay for a service you think you need, you’ll have to pay all of the costs if you didn’t ask for an advance coverage decision. Get your plan’s contact information from a Personalized Search (under General Search). or search by plan name .

    Find someone to talk to

    Find someone to talk to in your state





    Medicare hospice care #cape #may #motels

    #medicare hospice care

    #

    Compassion. Integrity. Excellence.

    Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

    At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

    Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

    Families

    Every patient is a unique story.
    Read more.


  • Healthcare Professionals

    We support our referring physicians.
    Find out how.


  • Volunteers and donors

    Make a difference in someone s life.
    Become a volunteer today.
    Learn how.





  • Medicare Hospice and Respite Coverage #faith #hospice

    #hospice care medicare

    #

    Medicare Hospice Care Coverage

    When you or a loved one becomes a hospice patient, the last thing you want to worry about is insurance coverage. The final stages of a fatal disease can be mentally, emotionally, physically, and financially devastating for patients and their families. Hospice care is available under Medicare Part A to help ease the burden in all four of the above areas.

    Hospice coverage is critical when a person reaches the final stages of cancer, kidney disease, or similar life-threatening diseases. The patient may need around-the-clock care during this time, and a hospice team can provide necessary medical care, while also relieving some of the caregiving burden.

    What is hospice care?

    Hospice care provides medical services for people with terminal conditions, usually in the patient’s home. A Medicare-approved hospice team administers non-curative medical services and support for patients with a terminal illness. This hospice team may include doctors, nurses, and other health professionals who work with you to create a plan of care.

    To be covered by Medicare, a hospice patient can only receive palliative treatment. This is treatment to control symptoms and manage pain, not to cure the illness. Hospice care is meant to keep the patient as comfortable as possible. The focus is on maximizing the quality of life for each day the patient has left.

    As a Medicare beneficiary, you have the right to stop hospice care at any time if you want to begin curative treatments.

    Hospice-care eligibility

    Not everyone is eligible for hospice care. Patients must meet the following requirements to be covered by Medicare:

    • You must be eligible for Medicare Part A .
    • You must sign a statement agreeing to hospice care instead of standard Medicare-covered medical care to treat the terminal illness and related health conditions.
    • You must agree to receive palliative care for your condition instead of curative treatment.
    • A hospice physician, along with your regular doctor (if you have one) must determine that you are terminally ill with a life expectancy of six months or less.
    • The hospice care must be received through a Medicare-approved hospice program.

    Length of hospice care

    Although hospice care is intended for patients who have six months or less to live, you can get hospice care for longer than this if a hospice doctor continues to certify that you’re terminally ill and you still meet eligibility requirements. You need to be recertified by your doctor at the beginning of each benefit period.

    Hospice-care benefit periods are for 90- or 60-day periods. If you’re just starting hospice care, you can receive hospice services for two 90-day benefit periods, followed by unlimited 60-day periods. Your benefit period starts on the first day you begin hospice care and ends after 90 or 60 days.

    Benefit periods don’t have to be consecutive. Hospice care may be cancelled at any time, and the patient may return to the standard Medicare benefits. For example, if your illness goes into remission or your condition improves, you may not need to continue you hospice care. If you’re eligible again, you may return to hospice care at any time.

    What Medicare hospice care covers

    Medicare hospice care covers medically necessary services and supplies to care for your terminal condition. As mentioned, any care you receive must be through a Medicare-approved hospice program.

    • A one-time hospice consultation with a physician or medical director to discuss your treatment options. You’re covered even if you end up deciding not to get hospice care.
    • Physician services
    • Nursing care
    • Home health and hospice-aide services
    • Homemaker services
    • Medical equipment and supplies
    • Prescription medications for pain and symptom management
    • Physical and occupational therapy
    • Speech-language pathology services
    • Medical social worker services
    • Nutrition counseling
    • Grief counseling for the patient and family
    • Limited respite care for caregivers
    • Limited inpatient care to manage pain and symptoms related to the condition

    A hospice doctor and nurse are on call 24 hours a day, seven days a week. Remember that you’re still covered for health care that isn’t related to your terminal illness.

    What Medicare hospice care doesn’t cover

    There are some limits to hospice coverage. Medicare will not pay for any treatment or medications meant to cure your illness. You’re also not covered for any care that wasn’t set up through your Medicare-approved hospice program. If you aren’t sure whether a service may be covered, check with your hospice team first.

    Medicare doesn’t cover housing if you live in an institution, such as a hospice facility or nursing home.

    Medicare does cover limited inpatient facility care if it’s for respite care and is arranged through your hospice team.

    Costs for hospice care

    Hospice patients pay the following costs:

    • Prescription drugs: Maximum of $5 copayment per outpatient prescription medication to manage pain and symptoms.
    • Respite care (inpatient): You ll pay 5% of the Medicare-approved amount for a maximum five-day stay. Note that you can get respite services more than once as long as it is on an infrequent basis.
    • Room and board: Medicare doesn’t cover costs if you’re staying in a nursing home or hospice facility, unless it’s for short-term respite care.

    Medicare covers all other hospice care costs. There’s no deductible for Medicare-covered hospice care.

    Hospice care may be worth looking into if you or a family member has been diagnosed with a terminal illness. Understanding all of your treatment options, including hospice, will help you decide the best course of action for you and your family.

    To learn about Medicare plans you may be eligible for, you can:

    • Contact the Medicare plan directly.
    • Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
    • Contact a licensed insurance agency such as Medicare Consumer Guide s parent company, eHealth.
      • Call eHealth s licensed insurance agents at 888-391-2659, TTY users 711. We are available Mon – Fri, 8am – 8pm ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
      • Or enter your zip code where requested on this page to see quote.




    Medicare hospice #spa #hotel

    #medicare hospice

    #

    Compassion. Integrity. Excellence.

    Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

    At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

    Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

    Families

    Every patient is a unique story.
    Read more.


  • Healthcare Professionals

    We support our referring physicians.
    Find out how.


  • Volunteers and donors

    Make a difference in someone s life.
    Become a volunteer today.
    Learn how.





  • Medicare Hospice Benefit-Topic Overview #motel #stari #hrast

    #medicare hospice benefit

    #

    Palliative Care Center

    Medicare is a health insurance program for people 65 years of age and older, for some people younger than 65 who have disabilities, and for people with long-term (chronic) kidney failure treated with dialysis or a transplant. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) of the United States government.

    The Medicare hospice benefit is described in Part A, which talks about hospital insurance. Part A benefits provide coverage for hospitals, nursing facilities (but not custodial or long-term care), some home health care. and hospice. People (including a spouse) who paid Medicare taxes while they were working are eligible for Part A benefits. A monthly payment, or premium, is not required for Part A benefits.

    Eligibility

    The Medicare hospice benefit provides coverage for services related to a life-limiting illness. Hospice care is covered under Medicare Part A benefits. You must meet all of the following criteria to be eligible for the Medicare hospice benefit:

    • You must be eligible for Medicare Part A benefits.
    • Your doctor and hospice medical director must certify that you have a life-limiting illness and are likely to live 6 months or less if your illness follows a normal course.
    • You must sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your life-limiting illness. (Medicare will still cover services for any health problem that is not related to your life-limiting illness.)
    • You must receive care from a hospice approved by Medicare.

    Covered services

    Medicare pays the hospice program a daily (per diem) rate that is intended to fully cover most services related to a life-limiting illness, including:

    • Hospice nursing care in your home. This includes intermittent visits by a nurse to check on your symptoms. Nurses are also available 24 hours a day, 7 days a week to visit if you need help. Live-in nursing care is not covered.
    • Medical supplies and equipment, such as a wheelchair, hospital bed, or incontinence pads.
    • Medicines for symptom control and pain relief. You will have to pay no more than $5 for each prescription drug and other related products.
    • Visits to your doctor to help manage your life-limiting illness.
    • Intermittent homemaker and home health aide services. The service of a live-in homemaker or home health aide is not covered.
    • Physical, occupational, or speech therapy, if needed because of your life-limiting illness.
    • Dietary counseling.
    • Visits from a counselor or social worker.
    • Spiritual care, if desired.
    • Visits from trained volunteers. Volunteers are available on a short-term basis to provide companionship, to help with your care, or to run errands.
    • Short-term respite care so your caregiver can rest or take some time off (you may need to pay a small copayment).
    • Temporary hospitalization, if needed, to help manage symptoms that cannot be controlled at home.
    • Counseling (called bereavement care) for your family, friends, and caregivers following your death.

    If your condition changes so that hospice is no longer appropriate, you can get your previous Medicare benefits reinstated. You can also re-apply for hospice benefits at a later time if needed.





    Medicare s Hospice Benefit: Little Known, Little Used #hospice #care #plans

    #medicare hospice benefit

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    Medicare’s Hospice Benefit: Little Known, Little Used

    Coping with a terminal illness can be a difficult enough experience without having to worry about pain management, medication costs, and assistance with caregiving. Surprisingly, many Medicare beneficiaries are unaware that Medicare’s all-inclusive Hospice Benefit is available to assist dying patients and their families with these issues at the end of life.

    The hospice benefit is “grossly underutilized,” says Mary T. Berthelot, a staff attorney with the Center for Medicare Advocacy. In 2000, only 23 percent of Medicare beneficiaries who died were enrolled in a hospice program.

    Hospice care offers a team-oriented approach to medical care, pain management, and emotional and spiritual support tailored to the dying patient’s needs and wishes. For patients who qualify, Medicare will pay for this kind of comprehensive end-of-life care delivered at home or in a hospice facility. The Medicare benefit includes many services not generally covered by Medicare and more than 90 percent of the more than 2,500 hospices in the United States are certified by Medicare.

    What the Hospice Benefit Covers

    Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Services are usually provided in the home. The Medicare Hospice Benefit provides for:

    • Physician and nurse practitioner services
    • Nursing care
    • Medical appliances and supplies
    • Drugs for symptom management and pain relief
    • Short-term inpatient and respite care
    • Homemaker and home health aide services
    • Counseling
    • Social work service
    • Spiritual care
    • Volunteer participation
    • Bereavement services

    Services are considered appropriate if they are aimed at improving the patient’s life and making her more comfortable. Physical, occupational and speech therapy, and even chemotherapy, may be covered if they are for comfort, not cure.

    Medicare will also pay for a hospice physician to consult with terminally ill patients who are not yet in a hospice. The consult, which could occur in a hospital, nursing home, other facility, or at home, may include a pain assessment as well as counseling on care options and advance care planning.

    One of the most important hospice benefits is its coverage of medication related to the terminal illness, which is covered at no more than a $5 copay. This alone can save a family a huge amount of money, since pain medication is extremely expensive.

    To be eligible for Medicare’s hospice benefit, a beneficiary must be entitled to Medicare Part A and be certified by a physician to have a life expectancy of six months or less if the illness runs its expected course. But living longer than six months doesn’t mean the patient loses the benefit. After the initial certification period, each beneficiary receives an unlimited number of additional 60-day periods. People can live for years on the hospice benefit as long as their physician or hospital medical director still believes that they have a life expectancy of six months or less.

    In addition, the patient must sign a statement electing the hospice benefit. By doing so, he is foregoing treatment to cure his illness and electing to receive only care to make his last days more comfortable, called “palliative” care. This is a big step for many patients and their families. The patient himself must make this election, provided he has capacity.

    A patient is not locked into the benefit once he elects it, however. It’s possible to revoke the benefit and reelect it later, and to do this as often as needed. There also is no requirement that the hospice beneficiary be homebound. And, contrary to popular belief, Medicare does not require patients to have a “do not resuscitate” order or advance directive to be admitted to a hospice program.

    Benefit recipients are allowed to keep their regular physician or nurse practitioner, and there may be a value in having an independent medical professional overseeing the care a patient receives from a hospice.

    What if the hospice beneficiary is a nursing home resident? The Medicare hospice benefit does not cover room and board in a nursing home, but if Medicaid (or some other payer) foots this bill, Medicare will pay for care related to the terminal illness. However, there must be a contract between the nursing home and the hospice providing the care, and this is something to look into when selecting a nursing facility.

    Many have the misconception that hospice care is reserved only for the last days of life. Sadly, the average length of stay in a hospice is a mere 25 days. But according to advocates, a frequent comment from patients and family members is “I wish I had it sooner.” Although the Medicare benefit cannot begin until six months prior to death, hospices in some states can begin delivering services much earlier.

    To find a hospice in your area, visit the Web site of the National Hospice and Palliative Care Organization (www.nhpco.org ), which offers a “Find a Hospice Program” tool, among other services.

    To download Medicare’s booklet on the hospice benefit in PDF format, click on: http://www.medicare.gov/Publications/Pubs/pdf/02154.pdf
    (If you do not have the free PDF reader installed on your computer, download it here .)





    Types of home health care that Medicare will pay for – Medicare

    #medicare hospice benefit

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    Types of home health care that Medicare will pay for

    Log In

    Create your free Medicare Interactive profile, and receive the following great benefits:

    • Bookmark your favorite courses and answers for quick reference, whether counseling a client, helping a family member, or simply brushing up on your Medicare knowledge
    • Receive a free exclusive resource: the New to Medicare Guide
    • Keep track of where you left off in MI Pro courses, and complete coursework at your own pace
    • Become part of a Medicare community and receive key Medicare reminders
    • Receive updates about Medicare Interactive and special discounts for MI Pro courses, webinars, and more

    If you qualify for the home health benefit, Medicare covers the following types of care:

    • Skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).
    • Medicare pays in full for skilled nursing care, which includes services and care that can only be performed safely and effectively by a licensed nurse. Injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient s condition, management and evaluation of a patient s care plan, and wound care are examples of skilled nursing care that Medicare may cover.
    • Medicare pays in full for a home health aide if you require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If you ONLY require personal care, you do NOT qualify for the Medicare home care benefit.
    • Skilled therapy services . Physical, speech and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury. Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength to a body area. Speech-language pathology services include exercises to regain and strengthen speech and language skills. Occupational therapy* helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes. Medicare should pay for therapy services to maintain your condition and prevent you from getting worse as long as these services require the skill or supervision of a licensed therapist, regardless of your potential to improve.
    • Medical social services . Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.
    • Medical supplies . Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency. such as wound dressings and catheters needed for your care.
    • Durable medical equipment. Medicare pays 80 percent of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20 percent coinsurance (plus up to 15 percent more if your home health agency does not accept assignment accept the Medicare-approved amount for a service as payment in full).

    *If you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. When your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you still need it.

    Related Answers
    Related Courses
    • Level 2: Medicare Coverage Rules –
      Course 1: Part A (Hospital Insurance)
    • Level 2: Medicare Coverage Rules –
      Course 2: Part B (Medical Insurance)
    Links




    Vitas accused of billing Medicare for bogus hospice charges #hospice #care #for

    #vitas hospice houston

    #

    Vitas accused of billing Medicare for bogus hospice charges

    Posted: 6:43 p.m. Friday, May 3, 2013

    The nation s largest hospice provider, South Florida-based Vitas, bilked Medicare by charging for people who were not terminally ill and sending crisis care bills for patients that nurses said were at church, bingo or the beauty parlor, federal officials allege.

    One Florida patient was nonresponsive yet also somehow walking in company records, according to a 51-page complaint that the U.S. Department of Justice filed under the False Claims Act.

    Company officials said Friday they will vigorously defend the lawsuit.

    An investigation by The Palm Beach Post last year showed Vitas, a for-profit hospice provider based in Miami, billed the government for local patient stays that averaged 40 percent longer than those at non-profit competitors licensed in Palm Beach County. The newspaper s reporting also showed hospice was marketed at assisted-living facilities as a service for people who might actually get better. Federal law requires hospice patients to be diagnosed with six months or less to live and to give up curative treatment.

    The federal complaint filed in U.S. District Court in Missouri on Thursday alleges a host of fraudulent billing practices in Florida and other states including California and Texas. Vitas operates 51 for-profit hospice programs in 18 states.

    The suit names Vitas Hospice Services LLC and Vitas Healthcare Corp. of Florida among others including parent corporation Chemed Corp. of Cincinnati, which also owns Roto-Rooter plumbing. Vitas is the larger of the two Chemed businesses. Medicare accounts for more than 90 percent of Vitas revenues, which exceeded $1 billion in 2012, the suit says.

    The government alleges Vitas focused on maximizing Medicare reimbursement for as many patients as possible while disregarding patients medical needs and Medicare guidelines.

    The hospice regularly ignored concerns expressed by its own physicians and nurses regarding whether its hospice patients were receiving appropriate care, the complaint said.

    The company s billing for highly expensive crisis care was nearly six times greater than the national average, accounting for 15 percent to 17 percent of its total revenue, according to the the suit.

    Chemed s stock fell more than 16 percent Friday in trading on the New York Stock Exchange.

    Chemed and Vitas intend to defend this lawsuit vigorously, a statement on Chemed s website said. Chemed and Vitas have made significant investments in controls, systems and procedures to uphold the highest industry standards and to maintain compliance with all regulatory requirements. Our compliance efforts are designed to ensure our services are provided only to eligible patients.

    But the complaint alleges the business practices of Chemed and Vitas led to the submission of false or fraudulent claims.

    Vitas and Chemed management regularly corresponded with Vitas field offices about each office s crisis care utilization, particularly when the crisis care rates were lower than defendants wanted, the complaint said.

    In one memo, according to the government, a Vitas vice president of operations grilled a Texas employee about a decreasing number of patients in crisis care a more intense level of care that can cost the government $742 more per day than standard home care.

    Would you give me your thoughts on what caused this drop and what will you be doing to correct in January? the memo said, according to the complaint. I will need this analysis by the end of the day today.

    The federal governement began paying for hospice care in the early 1980s. The idea was some dying patients might choose to give up often costly and wrenching last-ditch treatments for terminal illness to spend their final days in as much comfort and dignity as possible.

    Though many people think of hospice as a building, in most cases it is a service provided to patients in their own homes or in nursing homes or other facilities. Federal law requires a diagnosis of six months or less to live, though the complaint cited examples of patients on hospice for more than two years.

    Examples cited in the complaint ranged from 2006 to 2012. Individual patients were not identified by their full names.

    Patient TS in an unspecified Florida location was put on crisis care three different times over several months for conditions including weakness, anxiety and pain, but the government concluded she was never in crisis and required only an anti-anxiety drug at a low dose that should have been billed as routine home care.

    The complaint said five days after Vitas began billing Medicare for crisis care for TS, the Vitas doctor noted that TS was nonresponsive, but also wrote that TS was walking.

    Chemed set goals for the number of crisis care days it wanted Vitas to bill, according to the complaint.

    Employees trying to meet such goals reported some odd things to the government, the suit said: One Vitas nurse stated that, on more than one occasion when Vitas sent her to the homes of patients whom she was told needed crisis care, she arrived ready to perform intensive nursing care only to find that the patients were at church, the beauty parlor, or playing bingo.

    In an investigative report last year, The Palm Beach Post analyzed data showing local Vitas patients were staying on average 40 percent longer than those at non-profit competitors licensed in Palm Beach County. That meant higher bills for taxpayers. Such patients were less likely to have cancer and other fatal illnesses traditionally associated with hospice and more likely to have conditions such as dementia, The Post found. The newspaper also showed hospice services were being marketed at assisted-living facilities as a service for people who might not necessarily die — or even get better — though federal law requires a diagnosis of six months or less to live.

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    Home Health Providers – Centers for Medicare & Medicaid Services #when #does

    #home health care providers

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    Home Health Providers

    This page provides basic information about being certified as a Medicare and/or Medicaid home health provider and includes links to applicable laws, regulations, and compliance information.

    A Home Health Agency (HHA) is an agency or organization which:

    • Is primarily engaged in providing skilled nursing services and other therapeutic services; Has policies established by a group of professionals (associated with the agency or organization), including one or more physicians and one or more registered professional nurses, to govern the services which it provides;
    • Provides for supervision of above-mentioned services by a physician or registered professional nurse;
    • Maintains clinical records on all patients;
    • Is licensed pursuant to State or local law, or has approval as meeting the standards established for licensing by the State or locality;
    • Has in effect an overall plan and budget for institutional planning;
    • Meets the federal requirements in the interest of the health and safety of individuals who are furnished services by the HHA; and
    • Meets additional requirements as the Secretary finds necessary for the effective and efficient operation of the program.

    For purposes of Part A home health services under Title XVIII of the Social Security Act, the term home health agency does not include any agency or organization which is primarily for the care and treatment of mental diseases.

    A Home Health Agency may be a public, nonprofit or proprietary agency or a subdivision of such an agency or organization.

    1. Public agency is an agency operated by a State or local government. Examples include State-operated HHAs and county hospitals. For regulatory purposes, public means governmental.
    2. Nonprofit agency is a private (i.e. nongovernmental) agency exempt from Federal income taxation under 501 of the Internal Revenue Code of 1954. These HHAs are often supported, in part, by private contributions or other philanthropic sources, such as foundations. Examples include the nonprofit visiting nurse associations and Easter seal societies, as well as nonprofit hospitals.
    3. Proprietary agency is a private, profit-making agency or profit-making hospital.

    Downloads

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    Hospice medicare benefit #hotels #in #las #vegas

    #hospice medicare benefit

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    * The Medicare intermediary pays hospice 100% of allowable charges for those physician services furnished under arrangements with the hospice; hospice then provides payment to the physician. Billing through hospice is required for patients covered by the Hospice Medicare Benefit. A written agreement between the hospice and the covering or consulting physician is required.

    A ttending P hysician is the physician designated by the patient to have the most significant role in the determination and delivery of the individual’s medical care. As long as a physician is NOT the Hospice Medical Director, nor an employee or volunteer of Hospice Touch, professional services (office, hospital, home, or nursing home visits) continue to be covered under Medicare Part B.

    U nrelated S ervices: Professional services provided for treatment or management of conditions unrelated to the patient’s hospice terminal diagnosis should be billed using the GW modifier in box 24d of the HCFA 1500 form. The GW modifier alerts Medicare that the claim is for service not related to the hospice patient’s terminal condition.
    Note: Attending physicians CANNOT bill for outpatient services.

    C overing P hysician is the physician who sees the patient on behalf of the Attending Physician as part of vacation coverage or on-call status. The services of the substituting physician are to be billed by the Attending Physician under the reciprocal or locum tenens billing instructions. The Attending Physician must use the GV (related services) or GW (unrelated services) modifier in conjunction with either the Q5 or Q6 modifier. The Q5 modifier indicates services furnished by a substitute physician under a reciprocal billing arrangement, such as with a partner. Bill Hospice using HCFA 1500.

    C onsulting P hysician is the physician who provides direct patient care to a hospice patient for a condition related to the terminal illness.

    H ospice- r elated S ervices: A consulting Physician is required to obtain a referral from the Hospice Medical Director and/or the Attending Physician in order to perform services for a Hospice patient.

    Any physician (including clinical psychologists and psychiatrists) other than the Attending Physician (or Covering Physician) who provides services related to the hospice terminal diagnosis as part of the Plan of Care, must submit charges to Hospice Touch, which will then submit a claim to Medicare. Hospice Touch will pass on to the Consulting Physician the allowable Medicare rate. The Consulting Physician CANNOT bill for the balance of his/her services to the patient or other insurance provider(s). When billing as a Consulting Physician for approved hospice-related services, only consulting CPT codes may be used. The Consulting Physician is required to provide Hospice Touch with a written evaluation and/or recommended treatment plan.

    U nrelated S ervices: Any physician (including clinical psychologists and psychiatrists) other than the Attending Physician (or Covering Physician) who provides services not related to the terminal diagnosis bills his/her carrier for non-hospice reimbursement using the GW modifier in box 24d of the HCFA 1500 form. The GW modifier alerts Medicare that the claim is for services not related to the hospice patient’s terminal condition. This bill should also include the name of the hospice. Attending Physician in box 17, their UPIN number in box 17a, treatment diagnosis in box 21 (ICD-9 code – listed as a secondary diagnosis). Consulting physicians must also submit medical documentation, which states that the services were unrelated to the patient’s terminal condition. Bill Hospice using HCFA 1500.

    NOTE: R evoked o r D ischarged P atients: Services provided after a patient has revoked or is discharged from the hospice benefit should be billed without the GV or GW modifiers.





    What Is Medicare Conditions Of Participation? #hospice #chaplain #jobs

    #medicare hospice conditions of participation

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    What Is Medicare Conditions Of Participation?

    Medicare Conditions of Participation

    Medicare Conditions of Participation are a set of stringent health measures designed to regulate how hospitals and other medical establishments utilize Medicare aid. Every health-care facility which receives reimbursement for Medicare related costs must adhere to the guidelines specified by CMS, Center for Medicare Medicaid Services. These rules are published in the Federal Register and regular inspections assures that all health-care facility follow guidelines, consistently. These rules also make sure that all patients receive a minimum standard of health service, which is the right of every beneficiary.

    For example, the guidelines make sure that a hospital doing organ transplant has the necessary facilities, and that particular hospital only conducts business with a prescribed Organ Procurement Organization. Actually, the Medicare Conditions of Participation help streamline tasks, making it easier to keep the level of service consistent among all health-care facilities taking part in Medicare. According to the Code of Federal Regulations of October 2004, following are the Medicare Conditions of Participation for Hospitals:

    Part A General Provisions

    Basis and scope
    Provision of emergency services by nonparticipating hospitals

    Part B Administration

    Compliance with Federal, State and local laws
    Governing body
    Patients rights

    Part C Basic Hospital Functions

    Nursing services
    Medical record services
    Pharmaceutical services
    Radiological services
    Laboratory services
    Food and dietetic services
    Utilization review
    Physical environment
    Infection control
    Discharge planning
    Organ, tissue, and eye procurement

    Part D – Optional Hospital Services

    Surgical services
    Anesthesia services
    Nuclear medicine services
    Outpatient services
    Emergency services
    Rehabilitation services
    Respiratory care services

    Special provisions applying to psychiatric hospitals
    Special medical record requirements for psychiatric hospitals
    Special staff requirements for psychiatric hospitals
    Special requirements for hospital providers of long-term care services

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    Feds sue Hospice of the Comforter: Federal government sues Hospice of the

    #hospice of the comforter

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    Feds sue Hospice of the Comforter for Medicare fraud

    January 14, 2013 | By Kate Santich, Orlando Sentinel

    The federal government is suing Hospice of the Comforter for Medicare fraud, alleging that since at least 2005 the Altamonte Springs-based nonprofit knowingly billed for patients who were not terminally ill and even encouraged “creative” record-keeping to cover up the truth.

    The facility could face millions of dollars in fines and damages as a result.

    The suit, filed late last week by the U.S. Attorney’s Office, cites a case where the facility allegedly billed for hospice care over 4 1/2 years for an Alzheimer’s patient who was never considered terminally ill. Typically patients move to hospice care when they have less than six months to live.

    In another case, when a nurse noted that a patient’s current condition would not qualify for hospice care, the diagnosis was suddenly changed to rectal cancer, the suit says, though there was no evidence the patient had cancer at any point during her 287-day stay in hospice.

    At charges averaging more than $4,000 a month, bills for the two patients added up to more than $180,000 from Medicare the taxpayer-funded health-insurance program for the elderly and disabled.

    The suit specifically alleges that longtime hospice CEO Robert Wilson instructed employees to admit patients without determining whether they were terminally ill, as Medicare requires, and then to bill the federal program for reimbursement. Staff also was instructed to find ways to document the cases in patients’ medical files so that the billings appeared legitimate.

    Latour “LT” Lafferty, a Tampa attorney representing Hospice of the Comforter, said the charity “vehemently denies” that there was ever any intent to defraud the government. He also said management has been fully cooperative with the investigation and is trying to resolve the matter.

    “What I can tell you is that Bob [Robert Wilson] has always been and is fully committed to providing the highest quality of care to his patients, regardless of whether or not they’re reimbursed by the federal government,” Lafferty said. “So if a person comes to Hospice of the Comforter seeking care, Bob will be the first person to give it to them, regardless of payment.”

    Federal tax records show that Wilson made large bonuses based on how many patients were under hospice care each day.

    Tax returns filed with the Internal Revenue Service for 2009, for instance, show that Wilson earned a base salary of $122,000, plus patient bonuses of nearly $207,000 for the year. That did not include retirement pay and other deferred compensation, including a clergy-housing allowance, that brought his total to more than $362,000. Wilson is a chaplain.

    The latest allegations echo charges first made in October 2011 by a former hospice executive, who said he tried to get the hospice management to “do the right thing” by acknowledging improper Medicare billings and repaying the money.

    When that effort failed, former vice president of finance Douglas Stone said, he was fired by Hospice of the Comforter. Stone filed his own federal whistleblower case but agreed in August to let the Department of Justice pursue the matter instead.

    “I am pleased that after a more than yearlong investigation the Justice Department complaint describes in detail exactly what was alleged” in his own lawsuit, Stone said. “The Hospice of the Comforter Board of Directors had ample opportunity to do the right thing, follow the law, and return overpayments. Instead they allowed retaliation against a number of individuals making good faith efforts to report potential fraud.”

    Wilson, who co-founded the hospice in 1990 and helped establish its well-regarded reputation in the community, referred a request for his comments to Lafferty. The attorney said Wilson is no longer CEO at Hospice of the Comforter, but he remains its president as well as chairman of the Comforter Health Care Group Board of Directors, the hospice’s parent company.

    Although patients can and often do stay under hospice care for longer than the six-month guideline, a physician must periodically recertify the patient as terminally ill.

    But at Hospice of the Comforter, the suit says, if a review committee recommended that a patient be discharged, the hospice would order more tests to delay the discharge and continue billing Medicare.

    Wilson also had a list of patients whom nurses referred to in notes as FOBs, or “friends of Bob” who were not to be discharged regardless of what reviewers found, the suit says.

    The total amount of actual damages, the government said, would have to be determined at trial, but the law allows the court to fine hospice as much as triple that amount.

    Since May, Hospice of the Comforter has operated under a management agreement with Adventist Health System, the parent company of Florida Hospital chain, which reportedly had been interested in buying the facility at one point.

    Spokeswoman Samantha O’Lenick would not comment on the lawsuit, noting that Adventist Health’s contract with the hospice went into effect after the whistleblower lawsuit was filed and so is not involved.





    Medicare hospice regulations #what #is #terminally #ill

    #medicare hospice regulations

    #

    Hospice

    A public agency or private organization or unit of either providing to persons terminally ill and to their families, regardless of ability to pay, a centrally administered and autonomous continuum of palliative and supportive care, directed and coordinated by the hospice care team primarily in the patient’s home but may also be on an outpatient and short-term inpatient basis.

    Am I in the right place?
    • Will your facility have a medical director? If Yes. continue; If No Click here .
    • Will your facility be providing care to those patients who have a diagnosis indicating that they are terminally ill? ( terminally ill designated as 6 months to live). If Yes. continue; If No Click here .
    • Will you be providing regularly scheduled care consisting of medical, nursing, social, spiritual, and volunteer and bereavement services? If Yes. continue; If No Click here .
    • Will the care being provided be under a written care plan established and periodically reviewed by the patient’s attending physician or the medical director of the hospice? If Yes. continue; If No Click here .
    • Will you have an inpatient (acute or short-term care on a 24 hours basis) or residential (non-acute palliative care on 24 hours basis) hospice facility? If Yes. continue; If No Click here .
    Next Steps

    Continue this process by reading the Rules Regulations;
    Rules and Regulations for Hospice
    . Chapter 111-8-62, et seq. Revised December 9, 2009
    Enforcement of Licensing Requirements, Chapter 290-1-6, et seq. Effective August 16, 1993

    Complete the Application Packet – In order to process your application, ALL of the documents included in the application packet must be submitted; and

    Sign and return the Application Checklist with the entire Application Packet.





    Hospice care medicare #hotel #price #compare

    #hospice care medicare

    #

    Compassion. Integrity. Excellence.

    Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

    At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

    Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

    Families

    Every patient is a unique story.
    Read more.


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    Find out how.


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    Make a difference in someone s life.
    Become a volunteer today.
    Learn how.





  • Medicare – Long-Term Care Information #hospice #agency

    #medicare hospice

    #

    Medicare

    Medicare only covers medically necessary care and focuses on medical acute care. such as doctor visits, drugs, and hospital stays. Medicare coverage also focuses on short-term services for conditions that are expected to improve. such as physical therapy to help you regain your function after a fall or stroke. (In January of 2013 a lawsuit (Jimmo v. Sebelius) regarding the Medicare Improvement Standard was settled. The Settlement may result in changes to this requirement.)

    Eligibility

    Medicare pays for health care for people age 65 years and older. people under age 65 with certain disabilities. and people of all ages with end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant).

    Long-term Care Services Skilled Nursing

    Medicare does not pay the largest part of long-term care services or personal care such as help with bathing. or for supervision often called custodial care. Medicare will help pay for a short stay in a skilled nursing facility, for hospice care. or for home health care if you meet the following conditions:

    • You have had a recent prior hospital stay of at least three days
    • You are admitted to a Medicare -certified nursing facility within 30 days of your prior hospital stay
    • You need skilled care . such as skilled nursing services, physical therapy, or other types of therapy

    If you meet all these conditions, Medicare will pay for some of your costs for up to 100 days. For the first 20 days, Medicare pays 100 percent of your costs. For days 21 through 100, you pay your own expenses up to $140.00 per day (as of 2013), and Medicare pays any balance. You pay 100 percent of costs for each day you stay in a skilled nursing facility after day 100.

    Long-term Care Services Home and Other Care Services

    In addition to skilled nursing facility services, Medicare pays for the following services for a limited time when your doctor says they are medically necessary to treat an illness or injury:

    • Part-time or intermittent skilled nursing care
    • Physical therapy, occupational therapy, and speech-language pathology that your doctor orders that a Medicare -certified home health agency provides for a limited number of days only
    • Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease
    • Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20 percent of the Medicare approved amount

    There is no limit on how long you can receive any of these services as long as they remain medically necessary and your doctor reorders them every 60 days.

    Hospice care

    Medicare covers hospice care if you have a terminal illness and are not expected to live more than six months. If you qualify for hospice services, Medicare covers drugs to control symptoms of the illness and pain relief, medical and support services from a Medicare -approved hospice provider, and other services that Medicare does not otherwise cover, such as grief counseling. You may receive hospice care in your home, in a nursing home (if that is where you live), or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.

    Download or order the consumer handbook Medicare You 2013 to learn more about what Medicare does and does not cover.





    Medicare Benefit for Hospice Care – New York State #hotel #furniture

    #medicare hospice benefit

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    Hospice

    Hospice provides appropriate skilled, compassionate care to patients and their families so that they receive the support, help and guidance they need to meet the challenges of serious illness. A personalized plan of care incorporating what is important to the patient and the caregiver is developed. It is sensitive to their needs and emphasizes quality of life, and assists patients to live as fully and comfortably as possible. The philosophy of care called hospice has been practiced in New York State for more than two decades.

    Hospice:

    • Embraces all patients coping with advanced illnesses
    • Focuses on comfort rather than cure
    • Emphasizes quality of life
    • Promotes personal choice and individual dignity
    • Respects the traditions and wishes of the patient and the patient s family
    • Most often provides care in the patient s home, but when necessary, can also provide care in a nursing home and inpatient setting
    • Utilizes current treatments and medications
    • Addresses physical, social, emotional, and spiritual needs
    • Provides care and support to the bereaved

    Hospice Medicare Benefit

    Coping with a terminal illness can be a difficult enough experience without having to worry about pain management, medication costs, and assistance with caregiving. Surprisingly, many Medicare beneficiaries are unaware that Medicare s all-inclusive Hospice Benefit is available to assist dying patients and their families with these issues at the end of life. Hospice care offers a team-oriented approach to medical care, pain management, and emotional and spiritual support tailored to the dying patient s needs and wishes. For patients who qualify, Medicare will pay for this kind of comprehensive end-of-life care delivered at home or in a hospice facility. The Medicare benefit includes many services not generally covered by Medicare and more than 90 percent of the more than 2,500 hospices in the United States are certified by Medicare.

    Medicare Hospice Benefit Information

    Choosing hospice care is a difficult decision. The information in this booklet and support from a doctor and trained hospice care team can help you choose the most appropriate health care options for someone who’s terminally ill. This official government booklet for Medicare hospice benefits includes information about:

    • Who is eligible for Hospice care
    • What services are included
    • How to find a Hospice program
    • Where to get more information.

    Section Guide





    Hospice Center – Centers for Medicare & Medicaid Services #cheap #motels #in

    #medicare hospice

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    Hospice Center

    • The Centers for Medicare Medicaid Services (CMS) issued a final rule (CMS-1652-F ) that will update the Medicare hospice payment rates, hospice wage index, and cap amount for fiscal year (FY) 2017. As finalized, hospices will see an estimated 2.1 percent ($350 million) increase in Medicare payments for FY 2017. In addition, this rule finalizes changes to the hospice quality reporting program, including new quality measures. The final rule also describes a potential future enhanced data collection instrument as well as plans to publicly display quality measures and other hospice data beginning in the middle of 2017, and includes information regarding the Medicare Care Choices Model (MCCM).

    MLN Connects Provider eNews Spotlights

    • Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.

    Important Links

    Regulations and Related Transmittals

    Billing & Payment Information

    Wage Index Files

    Managed Care Information

    Medicare Hospice Data

    Medicaid Information

    Enrollment, Participation, & Certification

    Educational Resources

    Beneficiary Notices Initiative

    Uninsured Information

    Research and Analyses

    Hospice Face-to-Face

    Quality Initiatives

  • Hospice Assessment Intervention and Measurement (AIM) Project – Opens in a new window
  • Other Important Hospice Information

    Demonstration

    Coding

    • HCPCS – General Information
    • HCPCS Release Code Sets
    • ICD-9-CM and ICD-10
    • ICD-10
    • Claim Adjustment Reason and Remittance Advice Remark Codes – Opens in a new window

    National Provider Identifier (NPI)

    CMS Manuals & Transmittals

    Medicare Secondary Payer

    Fraud & Abuse

    How to Stay Informed

    General Provider Information – Coverage

    Coordination of Benefits

    Contacts

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    Types of home health care that Medicare will pay for – Medicare

    #medicare hospice benefit

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    Types of home health care that Medicare will pay for

    Log In

    Create your free Medicare Interactive profile, and receive the following great benefits:

    • Bookmark your favorite courses and answers for quick reference, whether counseling a client, helping a family member, or simply brushing up on your Medicare knowledge
    • Receive a free exclusive resource: the New to Medicare Guide
    • Keep track of where you left off in MI Pro courses, and complete coursework at your own pace
    • Become part of a Medicare community and receive key Medicare reminders
    • Receive updates about Medicare Interactive and special discounts for MI Pro courses, webinars, and more

    If you qualify for the home health benefit, Medicare covers the following types of care:

    • Skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).
    • Medicare pays in full for skilled nursing care, which includes services and care that can only be performed safely and effectively by a licensed nurse. Injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient s condition, management and evaluation of a patient s care plan, and wound care are examples of skilled nursing care that Medicare may cover.
    • Medicare pays in full for a home health aide if you require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If you ONLY require personal care, you do NOT qualify for the Medicare home care benefit.
    • Skilled therapy services . Physical, speech and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury. Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength to a body area. Speech-language pathology services include exercises to regain and strengthen speech and language skills. Occupational therapy* helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes. Medicare should pay for therapy services to maintain your condition and prevent you from getting worse as long as these services require the skill or supervision of a licensed therapist, regardless of your potential to improve.
    • Medical social services . Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.
    • Medical supplies . Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency. such as wound dressings and catheters needed for your care.
    • Durable medical equipment. Medicare pays 80 percent of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20 percent coinsurance (plus up to 15 percent more if your home health agency does not accept assignment accept the Medicare-approved amount for a service as payment in full).

    *If you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. When your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you still need it.

    Related Answers
    Related Courses
    • Level 2: Medicare Coverage Rules –
      Course 1: Part A (Hospital Insurance)
    • Level 2: Medicare Coverage Rules –
      Course 2: Part B (Medical Insurance)
    Links




    Medicare – Medicaid Cost Report l Owner Administrator Forum Seminar #hospice #care

    #medicare hospice billing

    #

    Florida Agencies Must submit claims for episodes beginning 10/1/2017

    New Course Offerring – OASIS C2 Begins 1/1/2017

    Medicare Training Consulting, Inc is currently accepting new clients.
    Please fill out our Cost Report Preparation Request form for a free quote.

    Medicare Training Consulting, Inc. was founded by Jim Plonsey in the Chicago area. After training Medicare auditors for Blue Cross Association, Jim established a business training Medicare auditors. This lead to doing cost reimbursement seminars for providers, most notably, home health agencies. Medicare Training Consulting, Inc. has become a leader in providing Owners and Administrators with the reimbursement strategies.

    Medicare Training & Consulting Owner Administrator Forum Seminars

    November 8-11, 2016

    The purpose of Medicare Training Consulting, Inc. is to become the primary source of needed current reimbursement information pertaining to Medicare providers. Medicare reimbursement has changed over the years. It is no longer merely filling out the cost report form. For example, home health agencies can provide outpatient therapy to non-homebound patients in their home under their current Part B license.

    Medicare Cost Report and Medicaid Cost Report

    Medicare Training and Consulting, Inc. provides vital information to assist providers in maintaining positive cash flow, defending Medicare audits,filing Medicare cost reports, and other reimbursement consulting. Medicare Training Consulting, Inc. has partnered with a consulting firm which review your prior claims and assist your agency with recovering this missed reimbursement.

    Chicago Fax: 708-251-2301

    Chicago Additional Fax. 708-895-0448

    ©1989-2016 Medicare Training Consulting Inc. All Rights Reserved.

    Medicare Training Consulting Inc.
    1905 Bernice Road Ste. 7
    Lansing, IL 60438





    Home Health Providers – Centers for Medicare & Medicaid Services #homestead #motel

    #home health care providers

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    Home Health Providers

    This page provides basic information about being certified as a Medicare and/or Medicaid home health provider and includes links to applicable laws, regulations, and compliance information.

    A Home Health Agency (HHA) is an agency or organization which:

    • Is primarily engaged in providing skilled nursing services and other therapeutic services; Has policies established by a group of professionals (associated with the agency or organization), including one or more physicians and one or more registered professional nurses, to govern the services which it provides;
    • Provides for supervision of above-mentioned services by a physician or registered professional nurse;
    • Maintains clinical records on all patients;
    • Is licensed pursuant to State or local law, or has approval as meeting the standards established for licensing by the State or locality;
    • Has in effect an overall plan and budget for institutional planning;
    • Meets the federal requirements in the interest of the health and safety of individuals who are furnished services by the HHA; and
    • Meets additional requirements as the Secretary finds necessary for the effective and efficient operation of the program.

    For purposes of Part A home health services under Title XVIII of the Social Security Act, the term home health agency does not include any agency or organization which is primarily for the care and treatment of mental diseases.

    A Home Health Agency may be a public, nonprofit or proprietary agency or a subdivision of such an agency or organization.

    1. Public agency is an agency operated by a State or local government. Examples include State-operated HHAs and county hospitals. For regulatory purposes, public means governmental.
    2. Nonprofit agency is a private (i.e. nongovernmental) agency exempt from Federal income taxation under 501 of the Internal Revenue Code of 1954. These HHAs are often supported, in part, by private contributions or other philanthropic sources, such as foundations. Examples include the nonprofit visiting nurse associations and Easter seal societies, as well as nonprofit hospitals.
    3. Proprietary agency is a private, profit-making agency or profit-making hospital.

    Downloads

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    Coding and Billing Information – Centers for Medicare & Medicaid Services #uk

    #home health service

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    Coding and Billing Information

    Home Health PPS Coding and Billing Information includes:

    • HH PPS HIPPS code weight table – See Downloads section below. These spreadsheets map each of the 1836 HIPPS code for the HH PPS to its associated case-mix weight.
    • Home Health PPS Grouper Software and Documentation – See Related Links Inside CMS below.
    • Health Insurance Prospective Payment System (HIPPS) Codes – See Related Links Inside CMS below.
    • Home Health PC Pricer – Program used by CMS to calculate Home Health Resource Group (HHRG) rates and all applicable adjustments. The link below also includes a user manual for the program. See Related Links Inside CMS below.
    • Home Health Consolidated Billing Master Code List – An Excel workbook file containing complete lists of all codes ever subject to consolidated billing provision of HH PPS. A master list worksheet shows the dates each code was included and excluded from consolidated billing editing on claims, with associated CMS transmittal references. The master list also associates each code with any related predecessor and successor codes. Supplemental worksheets show the list of included codes for each CMS transmittal to date. See Downloads section below.
    • Home Health PPS Wage Index Files – See Downloads section below.

    Downloads

    Related Links

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    7500 Security Boulevard, Baltimore, MD 21244

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    Medicare Hospice Data – Centers for Medicare & Medicaid Services #elizabeth #hospice

    #hospice statistics

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    Medicare Hospice Data

    Medicare Hospice Data Trends: 1998 2009

    Background

    To be eligible to elect the Medicare hospice benefit, beneficiaries must be certified by their attending physician (if any) and by the hospice physician as being terminally ill with a prognosis of 6 months or less to live, should the illness run its normal course. See the Hospice Data 1998-2009 file in the Downloads section below.

    Expenditures

    Expenditures for the Medicare hospice benefit have increased approximately $1 billion per year. In calendar year (CY) 1998, expenditures for the Medicare hospice benefit were $2.2 billion, while in CY 2009, expenditures for the Medicare hospice benefit were $12.1 billion [source: Health Care Information System (HCIS)].

    Number of Beneficiaries

    The table entitled Top 20 Hospice Terminal Diagnoses By Number of Patients provides a summary of hospice data from 1998 to 2009, using calendar year data from HCIS. This table shows the top 20 diagnoses for each year, based on the number of Medicare hospice patients with that diagnosis; the percentage of all Medicare patients for the year which that diagnosis represents; and the average length of stay for that diagnosis. The last row of the table provides the national total of patients for all diagnoses by year, along with the national average length of stay.

    The national totals by year clearly demonstrate that Medicare hospice expenditures are growing. There were more than twice as many Medicare hospice patients in 2009 than in 1998.

    Hospice Terminal Diagnoses

    The table also shows that the frequency of some hospice terminal diagnoses has changed over time, with relatively fewer cancer patients and relatively more non-cancer patients as a percentage of total hospice patients. Lung cancer has been recognized as the most common diagnosis among Medicare hospice patients every year since 1998. However, in 2006 non-Alzheimer s dementia became the most common diagnosis among Medicare hospice patients. The percentage of Medicare hospice patients with lung cancer dropped from 16% in 1998 to 9% in 2009. In addition, we are seeing a notable increase in the number of neurologically-based diagnoses. We are also seeing a marked increase in non-specific diagnoses such as Debility, Not Otherwise Specified , and Adult Failure to Thrive .

    Average Length of Stay

    Along with the shift in the mix of hospice patients, there exists a significant increase in the average length of stay (LOS) for hospice patients. In 1998, the average LOS for hospice patients was 48 days, but by 2006 it had risen to 73 days (a 52% increase). Since 2006, the average LOS has begun to decline slightly, dropping to 71 days in 2009, which is a 48% increase from 1998. Charts 1 and 2 show that the average LOS varies by diagnosis. For the top twenty diagnoses in 2009, the average LOS ranged from 27 days for chronic kidney disease to 106 days for Alzheimer s disease and other degenerative conditions. While the average LOS from 1998 2009 for hospice patients with diagnoses such as chronic kidney disease or cancers has remained relatively stable, the average LOS rose significantly for most other diagnoses, thought it has recently begun to decline slightly. Charts 1 and 2 graphically demonstrate the difference in the changes in lengths of stay for cancers versus other diagnoses in the top 20 list.

    Summary

    More Medicare beneficiaries are taking advantage of the quality and compassionate care provided through the hospice benefit. As greater numbers of beneficiaries have availed themselves of the benefit, the mix of hospice patients has changed, with relatively fewer cancer patients as a percentage of total patients.

    Note: Please refer to Hospice Data 1998-2008 file in Downloads section below to see 1998 statistics.

    Downloads





    2015 Hospice Billing Seminar l Medicare Training – Consulting #hotel #websites

    #hospice billing

    #

    Hospice Billing Seminars

    Receive training in Medicare billing for residential OR home-based hospice.

    Course Fee: $349 All Day, Per Person Early Bird Special: $319

    Medicare has finalized the New Cost Report forms. All Providers must use for the 2015 Cost Reporting Year. Providers must track costs by type of service (Routine, Continuous, etc.) throughout the year. CMS will implement new changes to approved software, which require on-going changes to payroll and financial tracking systems.

    Medicare billing is a crucial part of hospice reimbursement. Making sure that you are billing for the maximum reimbursement is critical to your success. Register today for this Hospice Billing Seminar and learn:

    Regulatory Updates

    Hospice Benefit Qualification

    Covered Services

    Reporting Requirements

    Documentation

    Checking Eligibility

    Hospice Claims

    Hospice Claim corrections

    Medicare Advantage Claims

    Notice of Election

    Discharges

    Notice of Revocation

    Transfers

    Face to Face

    Physician/Nurse Practitioner Services

    Care Plan Oversight

    Hospice CAP methodologies

    2016 Hospice Billing Dates and Locations

    Thursday, September 15, 2016

    Marriott Courtyard Dublin, OH

    Thursday, September 22, 2016

    LaQuinta Riverwalk San Antonio, TX

    Thursday, October 6, 2016

    Flamingo Las Vegas

    Thursday, November 17, 2016

    Marriott Courtyard Hobby

    Thursday, December 15, 2016

    Chicago / Oak Brook

    Thursday, December 18, 2016

    Harrah’s Las Vegas

    ©1989-2016 Medicare Training Consulting Inc. All Rights Reserved.

    Medicare Training Consulting Inc.
    1905 Bernice Road Ste. 7
    Lansing, IL 60438





    Medicare, Medi-Cal, and Private Insurance – Skirball Hospice #who #qualifies #for #hospice

    #medicare hospice coverage

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    Medicare, Medi-Cal, and Private Insurance

    Hospice care is a fully covered benefit under Medicare Part A and the Medi-Cal program in California. Most insurance companies also provide coverage for hospice care subject to individual policy deductibles, coinsurance, and out-of-pocket limitations.

    When a patient is considering hospice care, the insurance coverage of the patient will be reviewed and discussed with family members to be sure they understand the financial benefits provided to the patient by their current insurance carrier. If there are any questions, they will be resolved prior to the start of care.

    For an individual eligible and enrolled in Medicare or Medi-Cal, there is no out-of-pocket cost to select the hospice benefit. The hospice benefit includes full payment for all staff services, supplies, medical equipment, and medications, provided they are directly related to the hospice primary diagnosis.

    To qualify for hospice care, two physicians, generally the patient’s attending physician and the hospice physician, evaluate the patient to determine if the individual has a life-limiting illness with a life expectancy of six months or less if the disease process follows a normal course.

    Because it is impossible to know the progression of a disease with accuracy, patients may receive the hospice benefit for longer than six months provided they continue to meet the Medicare or insurance company eligibility criteria. After six months, patients are periodically assessed by hospice physicians for continued coverage.

    When an individual elects the hospice benefit for a specific disease diagnosis, they are opting out of traditional Medicare coverage and opting into the special Medicare hospice benefit. By doing this, they agree to pursue comfort and palliative measures only and not seek aggressive or curative therapy for that disease. Should other diseases develop, unrelated to the hospice diagnosis, those may be treated and covered under the traditional Medicare program.

    When all requirements are met, the following services will be covered by your health plan:

    • Physician services
    • Nursing care
    • Home health aide
    • Medical social services
    • Bereavement counseling
    • Spiritual counseling
    • Dietary counseling
    • Volunteer services
    • Physical therapy, occupational therapy, speech therapy
    • Medical equipment, services, and supplies
    • Medications for pain and comfort related to the terminal illness and approved by Skirball Hospice
    • Short-term inpatient care for pain and symptom control
    • Diagnostic studies
    • Short-term continuous care for focused symptom relief
    • Respite for up to 5 days to provide relief for caregivers

    The following services are not covered:

    • Treatment for the terminal illness which is not for palliative symptom management and is not within the hospice plan of care
    • Care provided by another hospice or home health agency
    • Private caregivers/sitter services
    • Dietary supplements unless directly related to terminal illness
    • Services not authorized by Skirball Hospice
    • Ambulance transportation not included in the plan of care
    • Supplies not related to terminal illness
    • Chemotherapy drugs or other drugs deemed aggressive in nature
    • Medications not related to the terminal illness
    • Visit to the emergency department or inpatient hospitalization without prior authorization from Skirball Hospice
    • Diagnostic studies or any treatments not authorized by Skirball Hospice

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