Home Care at the Crossroads: An Information Paper |
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... Home Care Services .. Page III V 1 346 Chapter 3. Access to Home Care : Medicare Program Rules and Regulations Create Barriers .... 9 The Prospective Payment System ( PPS ) Strains the Home Care System ..... 11 Increase in HCFA Denials for ...
... Home Care Services .. Page III V 1 346 Chapter 3. Access to Home Care : Medicare Program Rules and Regulations Create Barriers .... 9 The Prospective Payment System ( PPS ) Strains the Home Care System ..... 11 Increase in HCFA Denials for ...
Page 9
... denial was Mr. A who re- quired hemodialysis two times a week which cannot be per- formed at home . He also had visited a surgeon once a month at which time the physician surgically removed devitalized tissue from gangrenous areas on ...
... denial was Mr. A who re- quired hemodialysis two times a week which cannot be per- formed at home . He also had visited a surgeon once a month at which time the physician surgically removed devitalized tissue from gangrenous areas on ...
Page 10
... home health benefit , no matter how exceptional the circum- stances . Retroactive denials of coverage in cases that exceeded the 3 - week limit are not uncommon . In November 1986 , some fiscal intermediaries who adminis- ter the ...
... home health benefit , no matter how exceptional the circum- stances . Retroactive denials of coverage in cases that exceeded the 3 - week limit are not uncommon . In November 1986 , some fiscal intermediaries who adminis- ter the ...
Page 11
... home care services . The number of hospital patients discharged to home care rose by 37 percent from 1983 to 1986. Yet during the same period , reimbursement denials for home care claims rose by 133 percent ( Senate Special Committee on ...
... home care services . The number of hospital patients discharged to home care rose by 37 percent from 1983 to 1986. Yet during the same period , reimbursement denials for home care claims rose by 133 percent ( Senate Special Committee on ...
Page 12
... denials by their fiscal in- termediary . These cuts were significant because they occurred in a county where 18 percent of the population is 65 years or older . Fiscal intermediaries can deny a provider's claim on two grounds : The ...
... denials by their fiscal in- termediary . These cuts were significant because they occurred in a county where 18 percent of the population is 65 years or older . Fiscal intermediaries can deny a provider's claim on two grounds : The ...
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Common terms and phrases
ACCESS TO HOME accreditation addition Additionally areas assistance billion Budget Reconciliation Act client Committee on Aging Conditions of Participation Congressional costs coverage denials for home disabled elderly Federal fiscal intermediaries fiscal year 1988 funding sources HCFA Health and Human Health Care Financing HEALTH MAINTENANCE ORGANIZATIONS HMO's home care agencies home care benefit home care programs home care services home care worker home health agencies home health aides home health benefits home health care home health services homebound homemaker and chore hospital hospital-based home Human Services in-home services increases intermediary will deny long-term care services Medicaid Medicare beneficiaries Medicare patients Medicare Program Medicare's monitoring National League nursing home Older Americans Act older persons Omnibus Budget Reconciliation out-of-pocket physical therapy physician Prospective Payment System regulations reimbursement respite care Senate Special Committee Services Block Grant Social Services Block source of payment sumers supervision survey therapy tions U.S. Senate Special visits
Popular passages
Page 11 - Under PPS, predetermined fixed payment rates are set for each Medicare hospital inpatient admission, based on the diagnosis-related group (DRG) into which that admission falls. This fixed payment is an incentive for hospitals to limit costs spent on Medicare patients either by reducing lengths of stay or the intensity of care provided. As a result many older persons are being released from the hospital earlier and in need of more follow-up care than before the introduction of PPS. Consequently, State...
Page 4 - According to a plan of treatment established by a physician who has certified that the patient is confined to home and in need of intermittent skilled nursing care or physical or speech therapy. Medical insurance benefits may be paid for up to 100 home health visits in a calendar year. Since these benefits are in addition to those available under the hospital insurance plan...
Page 4 - In addition, the person must be in need of part-time or intermittent skilled nursing care or physical or speech therapy. Services must be provided by a home health agency certified to participate under Medicare, according to a plan of treatment prescribed and reviewed by a physician.
Page 7 - ... individuals decide to use more services than they otherwise would because they have insurance and/or will shift from nonpaid to paid providers for their care. In addition, insurers are concerned that, given the nature of many chronic conditions, persons who need long-term care will need it for the remainder of their lives, resulting in an open-ended liability for the insurance company. As a result of these risks, insurers have designed policies that limit their liability for paying claims. Policies...
Page 4 - Federal gove ment's share of the expenses is tied to a formula based on the per capita income of the State, with the Federal government paying a minimum of 50 percent and a maximum of 83 percent. Each State administers and operates its own program, and, subject to Federal guidelines, determines eligibility and the scope of benefits in the program. The programs vary widely from State to State. Eligibility...
Page 7 - This is to reduce the large potential demand for home care among the majority of the covered population that never has been institutionalized (GAO, May 1987).
Page 9 - Medicare program rules and regulations (64 percent) convey a perception that the Medicare program has changed the way in which individual eligibility and coverage determinations are made.
Page 3 - Dr. Marvin Cetron's written comments regarding the popularity of home care. He stated that in a study conducted by his organization it was found that 85 percent of the population favor insurance plans that encourage the care of the chronically ill at home. Even more encouraging was the statistic that home care is preferred by 72 percent of the American public over nursing homes. I was interested in one of the communities that was trying to develop a zoning code that would allow individuals to build...
Page 7 - Host of the life care facilities in existence are operated by private, non-profit organizations, especially religious organizations, although there has been increasing interest on the part of corporations in developing such facilities. In order to gain access to a life care facility, a resident is required to pay a lump sum entrance fee with monthly payments thereafter which are usually adjusted for inflation. Fees are generally based on the size and type of living unit (eg, studio, one-, two-, or...
Page 7 - ... limitations. Home care benefits, especially those related to custodial or personal care, are included in even fewer long-term care insurance policies. Often plans that cover any home care at all require a prior stay in a skilled nursing facility in order to reduce the large potential demand for home care among the majority of the covered population that has never been institutionalized. 37...