Home Health & Hospice Week

Is it time to branch into private pay?

The time may be right to rethink your business lines if you're serving only Medicare and Medicaid patients.

Centers for Medicare & Medicaid Services Administrator Mark McClellan announced the second phase of a campaign to help states promote private long-term care financing alternatives to Medicaid on July 26.

"Medicare doesn't cover long-term care, and Medicaid cannot afford to be the nation's primary source of payment" for LTC providers, McClellan says.

The demonstration's first phase began with five states, (Arkansas, Idaho, New Jersey, Nevada and Virginia), in January 2005. CMS helped participating state governors initiate an aggressive outreach campaign to individuals from 50 to 70 years of age.

Governors sent letters and financial planning toolkits to older adults containing information about using personal savings, trusts, annuities, LTC insurance and reverse mortgages to plan for LTC needs.

The second phase will last from January to May 2006. CMS will choose 10 states competitively and contribute $2.5 million to the demonstration.

More information is at www.ltcaware.info.  The competitive bidding rule for durable medical equipment is getting closer to publication. The proposed rule is currently in the clearance phase, a CMS official said during the July 20 Open Door Forum. The agency expects to publish the rule in late summer.
  What's in a name? A whole lot, if you're a provider submitting claims to the Region B DMERC.

Adminastar Federal's claims department is currently returning to suppliers an average of 200 to 300 claims a day due to the supplier failing to include the correct beneficiary information. In Box 2 of the CMS 1500 form, the supplier should be entering the beneficiary's name exactly as it appears on his or her Medicare card.

Failure to do so will cause the claim to be deleted and returned to the supplier, the DMERC says.
  Ohio is expanding one of its PACE programs. The state budget bill finalized June 30 will furnish funding for 60 more slots in the Program for All-Inclusive Care for the Elderly run by TriHealth's SeniorLink program, reports the Cincinnati Business Courier. PACE is a federally funded program that aims to keep seniors at home and out of nursing homes.

SeniorLink centers in the Cincinnati area now serve 370 clients and have funding for 440. That will increase to 500 next year. Concordia Care in Cleveland will continue to have funding for 380 spots.
  But DME suppliers are worried about proposed Medicaid changes in Ohio. The state is proposing big changes to some Medicaid rules, according to the Ohio Association of Medical Equipment Services.

For example, Ohio plans to implement what it calls "volume purchasing" for DME - a reimbursement model that resembles national competitive bidding. The state also plans changes regarding oxygen [...]