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.
