TRICARE’s home health care benefits are similar to those covered under Medicare. To qualify for TRICARE coverage of any home health care services, the patient must meet each of the following criteria:
• Patient is confined to the home
• Services are provided under a plan of care established and approved by a physician
• Patient is under the care of the physician who approved the plan of care
• Patient needs one of the following types of services:
• Skilled nursing care that is reasonable and necessary (as defined in the TRICARE
Reimbursement Manual, Chapter 12, Section 2)
• Psychiatric evaluation, therapy, and teaching (covered as a skilled nursing service)
• Intermittent skilled nursing care*
• Skilled therapy services (i.e., physical therapy, speech-language pathology,
or occupational therapy)
If a patient qualifies for coverage of home health care services, TRICARE covers a limited number of hours per week of either part-time or intermittent services. All home health care must be provided by a participating home health care agency.
It is important to note that assistance with activities of daily living (e.g., washing laundry, cleaning dishes) is not part of the home health benefit. While the home health care professional may provide some assistance with basic daily living care, these tasks are not separately reimbursable and are not their primary duties while in the
patient’s home.
You may refer to www.triwest.com/provider to access the Home Health Agency Prospective
Payment System eSeminar. You may view the eSeminar 24 hours a day, seven days a week
from most computers with Internet access
Showing posts with label coverage and benefits. Show all posts
Showing posts with label coverage and benefits. Show all posts
Monday, May 21, 2012
Monday, March 14, 2011
complaint about home health agency service
Where to file a complaint about the quality of your home health care
If you have a complaint about the quality of care you’re getting from a home health agency, you should call either of the following organizations:
Your state home health hotline. Your home health agency should give you this number when you start getting home health services.
The Quality Improvement Organization (QIO) in your state.
The QIO is a group of practicing doctors and other health care experts paid by the Federal government to check and improve the care given to Medicare patients. To get the telephone number for your QIO, visit www.medicare.gov. You can also call 1-800-MEDICARE.
If you have a complaint about the quality of care you’re getting from a home health agency, you should call either of the following organizations:
Your state home health hotline. Your home health agency should give you this number when you start getting home health services.
The Quality Improvement Organization (QIO) in your state.
The QIO is a group of practicing doctors and other health care experts paid by the Federal government to check and improve the care given to Medicare patients. To get the telephone number for your QIO, visit www.medicare.gov. You can also call 1-800-MEDICARE.
Saturday, March 12, 2011
Getting Home Health Care
Usually, once your doctor refers you for home health services, staff from the home health agency will come to your home to talk to you about your needs and ask you some questions about your health. The home health agency will also talk to your doctor about your care and keep your doctor updated about your progress. Doctor’s orders are needed to start care.
Your plan of care
Your home health agency will work with you and your doctor to develop your plan of care. A plan of care lists what kind of services and care you should get for your health problem. You have the right to be involved in any decisions about your Your plan of care includes the following:
* What services you need
* Which health care professionals should give these services
* How often you will need the services
* The medical equipment you need
* What results your doctor expects from your treatment
Your home health agency must provide you with all the home care listed in your plan of care, including services and medical supplies. The agency may do this through its own staff or through an arrangement with another agency; or by hiring nurses, therapists, home health aides, and medical social service counselors to meet your needs.
Your doctor and home health team review your plan of care as often as necessary, but at least once every 60 days. If your health problems change, the home health team should tell your doctor right away. Your plan of care will be reviewed and may change. Your home health team should only change your plan of care with your doctor’s approval. Your home health team should also tell you about any changes in your plan of care. If you have a question about your care, or if you feel your needs aren’t being met, talk to both your doctor and the home health team.
The home health team will teach you (and your family or friends who are helping you) to continue any care you may need, including wound care, therapy, and disease management. You should learn to recognize problems like infection or shortness of breath, and know what to do or whom to contact if they happen.
Your plan of care
Your home health agency will work with you and your doctor to develop your plan of care. A plan of care lists what kind of services and care you should get for your health problem. You have the right to be involved in any decisions about your Your plan of care includes the following:
* What services you need
* Which health care professionals should give these services
* How often you will need the services
* The medical equipment you need
* What results your doctor expects from your treatment
Your home health agency must provide you with all the home care listed in your plan of care, including services and medical supplies. The agency may do this through its own staff or through an arrangement with another agency; or by hiring nurses, therapists, home health aides, and medical social service counselors to meet your needs.
Your doctor and home health team review your plan of care as often as necessary, but at least once every 60 days. If your health problems change, the home health team should tell your doctor right away. Your plan of care will be reviewed and may change. Your home health team should only change your plan of care with your doctor’s approval. Your home health team should also tell you about any changes in your plan of care. If you have a question about your care, or if you feel your needs aren’t being met, talk to both your doctor and the home health team.
The home health team will teach you (and your family or friends who are helping you) to continue any care you may need, including wound care, therapy, and disease management. You should learn to recognize problems like infection or shortness of breath, and know what to do or whom to contact if they happen.
Tuesday, March 8, 2011
Finding Medicare certified home health agency
Finding a Medicare-certified home health agency
If your doctor decides you need home health care, you may choose an agency from the participating Medicare-certified home health agencies that serve your area. Home health agencies are certified to make sure they meet certain Federal health and safety requirements. Your choice should be honored by your doctor, hospital discharge planner, or other referring agency. You have a say in which agency you use, but your choices may be limited by agency availability, or by your insurance coverage. (Medicare Advantage Plans or other Medicare health plans may require that you get home health services from agencies they contract with.)
Comparing home health agencies
Use Medicare’s “Home Health Compare” web tool by visiting
www.medicare.gov/HHCompare to compare home health agencies in your area. You can compare home health agencies by the types of services they offer and the quality of care they provide. Home Health Compare provides the following information about home health agencies:
*Name, address, and telephone number
* Services offered (such as nursing care, physical therapy, * occupational therapy, speech-language pathology services, medical/social services, and home health aide services)
*Initial date of Medicare certification
* Type of ownership (For Profit, Government, Non-Profit)
Information about the quality of care provided (quality measures)
If your doctor decides you need home health care, you may choose an agency from the participating Medicare-certified home health agencies that serve your area. Home health agencies are certified to make sure they meet certain Federal health and safety requirements. Your choice should be honored by your doctor, hospital discharge planner, or other referring agency. You have a say in which agency you use, but your choices may be limited by agency availability, or by your insurance coverage. (Medicare Advantage Plans or other Medicare health plans may require that you get home health services from agencies they contract with.)
Comparing home health agencies
Use Medicare’s “Home Health Compare” web tool by visiting
www.medicare.gov/HHCompare to compare home health agencies in your area. You can compare home health agencies by the types of services they offer and the quality of care they provide. Home Health Compare provides the following information about home health agencies:
*Name, address, and telephone number
* Services offered (such as nursing care, physical therapy, * occupational therapy, speech-language pathology services, medical/social services, and home health aide services)
*Initial date of Medicare certification
* Type of ownership (For Profit, Government, Non-Profit)
Information about the quality of care provided (quality measures)
Friday, March 4, 2011
WHAT IS NOT Covered under home health billing
What isn’t covered?
Below are some examples of what Medicare doesn’t pay for:
** 24-hour-a-day care at home.
* Meals delivered to your home.
Homemaker services like shopping, cleaning, and laundry when this is the only care you need, and when these services aren’t related to your plan of care. See page 19.
Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.
Talk to your doctor or the home health agency if you have questions about whether certain services are covered. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Note: If you have a Medigap (Medicare Supplement Insurance) policy or other health insurance coverage, be sure to tell your doctor or other health care provider so your bills get paid correctly.
Below are some examples of what Medicare doesn’t pay for:
** 24-hour-a-day care at home.
* Meals delivered to your home.
Homemaker services like shopping, cleaning, and laundry when this is the only care you need, and when these services aren’t related to your plan of care. See page 19.
Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.
Talk to your doctor or the home health agency if you have questions about whether certain services are covered. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Note: If you have a Medigap (Medicare Supplement Insurance) policy or other health insurance coverage, be sure to tell your doctor or other health care provider so your bills get paid correctly.
Saturday, February 26, 2011
who is eligible for Medicare savings program
Medicare Savings Programs (Help with Medicare costs)
States have programs that pay Medicare premiums and, in some cases, may also pay your Part A (Hospital Insurance) and Part B (Medical Insurance) deductibles and coinsurance. These programs help people with Medicare save money each year.
To qualify for a Medicare Savings Program, you must meet all of these conditions:
Have Part A
Single person—Have monthly income less than $1,239 and resources less than $8,100
Married and living with a spouse—Have monthly income less than $1,660 and resources less than $12,910
Note: These amounts may change each year. Many states figure your income and resources differently or may not have limits at all, so you may qualify in your state even if your income is higher. Resources include money in a checking or savings account, stocks, and bonds. Resources don’t include your home, car, burial plot, up to $1,500 for burial expenses (per person), furniture, or other household items.
States have programs that pay Medicare premiums and, in some cases, may also pay your Part A (Hospital Insurance) and Part B (Medical Insurance) deductibles and coinsurance. These programs help people with Medicare save money each year.
To qualify for a Medicare Savings Program, you must meet all of these conditions:
Have Part A
Single person—Have monthly income less than $1,239 and resources less than $8,100
Married and living with a spouse—Have monthly income less than $1,660 and resources less than $12,910
Note: These amounts may change each year. Many states figure your income and resources differently or may not have limits at all, so you may qualify in your state even if your income is higher. Resources include money in a checking or savings account, stocks, and bonds. Resources don’t include your home, car, burial plot, up to $1,500 for burial expenses (per person), furniture, or other household items.
Saturday, February 19, 2011
Patient rights on home health billing
Your rights as a person with Medicare
In general, as a person with Medicare getting home health care from a Medicare-certified home health agency, you’re guaranteed certain rights, including the following:
* To get a written notice of your rights before your care starts
* To have your home and property treated with respect
* To be told, in advance, what care you will be getting and when your plan of care is going to change
* To participate in your care planning and treatment
* To get written information about your privacy rights and your appeal rights
* To have your personal information kept private
*To get written and verbal information about how much Medicare is expected to pay and how much you will have to pay for any services that you will be getting
* To make complaints about your care and have the home health agency follow up on them
*To know the phone number of the home-health hotline in your state where you can call with complaints or questions about your care
Read more about these rights and protections in the following publications:
“Your
Medicare Rights and Protections”—Visit
http://go.usa.gov/low.
“Medicare & You” handbook—Visit ■■http://go.usa.gov/iDJ.
You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
In general, as a person with Medicare getting home health care from a Medicare-certified home health agency, you’re guaranteed certain rights, including the following:
* To get a written notice of your rights before your care starts
* To have your home and property treated with respect
* To be told, in advance, what care you will be getting and when your plan of care is going to change
* To participate in your care planning and treatment
* To get written information about your privacy rights and your appeal rights
* To have your personal information kept private
*To get written and verbal information about how much Medicare is expected to pay and how much you will have to pay for any services that you will be getting
* To make complaints about your care and have the home health agency follow up on them
*To know the phone number of the home-health hotline in your state where you can call with complaints or questions about your care
Read more about these rights and protections in the following publications:
“Your
Medicare Rights and Protections”—Visit
http://go.usa.gov/low.
“Medicare & You” handbook—Visit ■■http://go.usa.gov/iDJ.
You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
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