Question for Medicare experts

[honestagent]

As a sidenote, there are specific certified medicare homecare agenices that will assist those who have chronic needs and or were recently discharged from a hospital that can assist for 'an hour, a few, or less.' The benefit of homecare has many within that can help those a great deal if implemented accordingly.

It's all paid through their Medicare, Part A - assuming Medicare is Primary. For what you've characterized, however, they're in for a different challenge. Good luck.

For the future, check out this website, type your zip, and you can see what agencies are homecare certified for future reference if you have a customer or client who needs 'some' help free of cost.


Medicare.gov - Home Health Compare - Agency Search

Here's the situation. Have a client who was recieving skilled care at home for neuoraphathy which was paid for by Medicare. At the same time, his wife had a knee replacement and could not help with his ADL's and needed someone to come in a night and help him get to the bathroom, etc. So, the daughter had an agency come in and stay at night to help with his activities of daily living. The daughters were there to do it during the day.

Problem is, they used an agency that was not Medicare approved. Now they have a $3500 bill. My understanding is, had they used an approved facility for the informal care, Medicare would have paid as long as he was also recieving skilled care, correct? He is also confined to home so that settles that requirement.

Has anyone had any experience with Medicare still paying a claim even from a facility not approved by them? My client called Medicare about it and they told her to have the facility send it to Medicare and they would pay. The facility said they won't do this. I called Medicare and they told me to fill out a claim and send in the bills and they might pay it.

Any and all opinions or experiences would be appreciated.

One final rant on this, they have spoken to many of the medicare approved facilities and they say they don't provide informal care, only skilled care in blocks of one hour. Who is a client supposed to recieve the informal care from during skilled at home care if the medicare approved agencies don't do it and the agencies who do do it aren't approved. It seems kind of screwed up to me.

 

[atthewood]

If she is receiving care at home it would not fall under the Skilled Nursing facility benefit of Medicare Part A. It would come under Part B, Home Health Care.
I don't know what state you're in but in FL we have a fairly new Medicaid level called MWA. It's a Medicare Waiver program for Home and Community Services. The income level is much higher than traditional Medicaid levels and they provide assistance in the beni's home which includes services like grocery shopping, home companion, several days a week. It cost the state a lot less then and inpatient stay in rehab facility.

 

[TN_agent]

Holy necro Batman!