Home Health & Hospice Week
Disease Management Saves Thousands Per Patient
Major insurer to test heart failure DM.
Payors seem to finally be wising up that an ounce of prevention is worth a pound of cure - and the result could be more home care patients.
A new study found that elderly heart failure patients who received specialized nursing care during their hospital stay and after discharge at home had better quality of life and fewer hospital readmissions.
Heart failure patients experience breakdowns in care during multiple transitions from hospital to home, says the study funded by the National Institutes of Health' National Institute of Nursing Research and published in the May issue of the Journal of American Geriatrics Society.
While furnishing the study participants with disease management care cost more up front than regular hospital services, the reduction to hospital admissions saved the Medicare program 38 percent overall - $4,845 per patient, found the study conducted by University of Pennsylvania researchers.
A "major health insurer" has launched a $1 million pilot project to test the study's findings in New Jersey, Delaware and Pennsylvania this summer, NIH says in a release.
Advanced practice nurses visited study patients within 24 hours of hospital admission and, upon discharge, the nurses conducted home visits within 24 hours of discharge and were available by phone.
Starting last month, remark code N115 has been telling providers the claim was denied due to a local medical review policy or local coverage determination. And starting this October, beneficiaries' Medicare Summary Notices will contain that message as well, plus any relevant national coverage determination, along with the specific LMRP, LCD or NCD number used for the denial, the Centers for Medicare & Medicaid Services says in May 14 Transmittal No. 75.
"For each full or partial denial that is based on an LMRP or NCD, the MSN will have to specify the LMRP/LCD ID number(s) and/or NCD number(s) of the [policies] that were used," CMS tells contractors.
The Louisville, KY-based company saw revenues from its visiting nurse Caretenders business increase nearly 10 percent to $8.3 million for the quarter ended March 31. "Focusing our attention on the growth prospects of this segment continues to pay off," CEO William Yarmuth says in a release.
Almost Family has opened two new Medicare-certified agencies in Florida, it says. The company's revenues for its personal care business line increased 1 percent to $8.1 million for the quarter.
Overall, Almost Family reported net income of $301,000 on revenues of $22.0 million for the quarter, compared to a $238,000 profit on $21.5 million in revenues for the same period in 2003.
But Beverly's home care revenues have increased during the same time, from $8.3 million to $11.0 million.
Gupta and the other defendants "created a scheme to defraud Medicare based upon violations of the 'related party' regulation by use of false claims, straw owners, and other deceptive actions to conceal the close relationship between the various persons," according to U.S. v. Gupta, et al (No. 02-16337).
The U.S. District Court for the Southern District of Florida had ordered an acquittal or new trial for Gupta and his companies, which were originally found guilty of the fraud counts in late 1999.
But Gupta's motion for reconsideration, which sparked the acquittal, was filed well outside of clearly established allowable deadlines, the U.S. Court of Appeals for the Eleventh Circuit says in a March 29 decision.
The Appeals Court reinstated the jury's fraud verdict and sent the case back to Florida district court for Gupta's sentencing.
The six companies are Allegheny Management Company, Cardinal Care Inc., Marshall Medical Services Inc., Atlantic Health Care Services Inc., West Coast Health Care Services Inc. and Treasure Coast Health Care Services Inc.
Home Health & Hospice Week
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Disease Management Saves Thousands Per Patient
Major insurer to test heart failure DM.
Payors seem to finally be wising up that an [...]
