Home Health & Hospice Still Best Deal For Medicare - 6/29/2015

Are you tired of hearing how Home Health Agencies and Hospices are ripping off the Medicare Program?  I know I am.  Off course there are some bad actors in the home health and hospice industry, but recent headlines show there are bad actors in the entire health care industry including Hospitals, Nursing Homes, Suppliers, Pharmacy, DME, and Physicians.

I am concerned that the government is very quick to apply the words Fraud and Abuse.  I know many health care providers have been hit by various outside government auditors (AKA Bounty Hunters) who may be denying claims incorrectly.  The RAC’s, ZPIC’s and other auditors have been out of control.  If that were not true why has the administrative appeal program been completely overwhelmed. 

The more complicated CMS makes the health care rules and regulations the more providers, suppliers and physicians fall short.  We would all like some black and white rules instead of the convoluted mess we have today.  I find that health care providers, suppliers, and physicians must always be perfect and never make a mistake.  If they do make a mistake it is always carries the label of Fraud or Abuse.  The Medicare contractors can make mistakes all of the time.  Once in a blue moon they will be cited with Fraud or Abuse.  Mom was always right: “sometimes things are just not fair”

I believe that light at the end of the tunnel has been turned back on in the past few months.  The hospital industry has received a settlement proposal on denials, Face-To-Face is being looked at by Congress, and the Medicare program has finally began to look at outcomes.

Medicare beneficiaries much prefer care in their homes instead of nursing facilities.  Hospice care is the preference of beneficiaries when their life expectancy is less than 6 months.  Caring for patient at home is much less costly than facility care.  Hospice care is much less costly than traditional Medicare for patients who have a life expectancy of less than 6 months. 

The pendulum is swinging back.  One state will begin providing meals an

d home care services to Medicaid eligible nursing home patients beginning in January 2016.  It currently cost them $49,000 per patient for long term care compared to the $15,000 per patient for patient care services and meals in the patient’s home.  Not only will it cost less, but the patients will be much happier at home.  You can look for other states to adopt similar programs in the future.