The federal government has been cracking down on fraud and abuse of the home care system for some time, and that means there are issues causing agencies and other providers some confusion and frustration. One of the issues that has arisen of late is the fact that some agencies are denying services for men and women who rely on Medicare support.
In most cases, these agencies are claiming the services needed will not be covered by Medicare, such as would be the case for an individual diagnosed with a serious medical condition who is unable to care for himself or herself. This common belief is often rooted in these new federal guidelines and regulations that are causing confusion among agencies.
As noted by Kaiser Health News, in their blog, Home Care Agencies Often Wrongly Deny Medicare Help [t]o [t]he Chronically Ill, written by Susan Jaffe:
“The former computer systems manager has Medicare coverage because of his disability, but no fewer than 14 home health care providers have told him he can’t use it to pay for their services.
That’s an incorrect but common belief. Medicare does cover home care services for patients who qualify, but incentives intended to combat fraud and reward high quality care are driving some home health agencies to avoid taking on long-term patients such as Campbell, who have debilitating conditions that won’t get better, according to advocates for seniors and the home care industry. Rule changes that took effect this month could make the problem worse.”
If agencies are gearing up to focus more on short-term clients, then this could be leaving those who need long-term care struggling to find adequate support. The trouble may be brewing due to changes the federal government is making to help combat fraud and abuse of the system, but as many home care advocates have claimed during these past few years, many of the changes are confusing and place an inordinate burden on the agencies themselves, which is forcing them out of the service of those men and women relying on Medicare and Medicaid strictly due to cost factors.
If it costs more to handle an influx of paperwork and services that are required and provided are then being denied reimbursement later on, this could be a major contributing factor to the dilemma at hand. While seniors and others certainly need to be well-informed regarding what is covered by Medicare and Medicaid, agencies also need to be certain regarding the services that will be covered and that may require more clarification at the federal level.
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