Do you have a health care question? Ask us here and we’ll do our best to answer it for you or direct you to a resource that can help.
Questions & Answers
- Home Health Visits: Frequency and Duration July 23, 2015
Q: How many days can a provider come to your home weekly and how many hours do they stay?
A: Home health agencies are not under any restrictions for frequency or duration of home visits. Usually visit frequencies are set initially in the nursing care plan approved by the attending physician. Home health agencies are reimbursed in episodic payments for all nursing care given within 60 days.
- Can a Physician’s Assistant Bill for G0180 Under CPO? June 3, 2014
Question: Can a physician’s assistant (under supervision of an MD) bill for G0180?
Answer: Certification G0180 is the initial certification of a patient for Medicare-covered home health services. This code is used when the patient has not received Medicare-covered home health care for at least 60 days. The work this certification process requires includes: ordering the plan of care, signing the 485, and documenting the face-to-face encounter. Only physicians are allowed to bill for initial Certification and Recertification billing, however physician assistants, as well as nurse practitioners, may provide care plan …
- CPO Reimbursement Rates June 2, 2014
Question: Do you know where I can find the reimbursement rates by state for CPO?Answer: Amedisys has published a useful guide about care plan oversight, which includes reimbursement rates by state and region. To download this guide, go here.
- Skilled nursing facility care – What are the requirements? March 26, 2014
My mother is unable to walk without assistance by wheelchair or walker, cannot bathe on her own, has lower body assist, has dementia and fear of falling, and is on diapers, but the facility says she is highly functional. What are her chances of getting into a skilled nursing facility?
- Question about Medigap and Medicare November 29, 2013
We recently received a question about Medigap and Medicare coverage.
Question: I have chronic inflammatory demyelinating polyneuropathy. I have to get IVIGs of gamunex-C. I have a nurse who comes in and gives me the IVIG which takes 6 hours. I am not house ridden, so is this covered by home health care? It is very expensive and I am very lucky my supplemental health care in New York covers this after I meet the deductible. I will be moving to North Carolina at the end of December and need to find out what Medicare covers and if there is …
- Are Medicare Advantage Plans required to provide the same home health care benefit as Original Medicare? November 18, 2013
Although Medicare Advantage plans must follow Original Medicare’s rules for providing you care, they can impose different costs and restrictions (often expensive co-pays and high deductibles).
- CMS Releases “2 Midnights” Rule October 22, 2013
Question: Why does CMS want to decrease the number of extended observation stays?
Answer: Extended observation stays have a negative impact on beneficiaries since they require a 20 percent co-pay for the service and do not count towards the 3 inpatient day stay required for Medicare coverage skilled nursing facility (SNF) admissions.
- Time to Pick a Medicare Part D Plan October 15, 2013
Question: Can I be penalized for not joining a Medicare prescription drug plan when I’m first eligible?
Answer: Yes. If you don’t join a Medicare prescription drug plan when you’re first eligible or go without prescription drug coverage for a period of 63 or more days in a row after you qualify, you may have to pay a late-enrollment penalty.
- What People Who Live to 100 Have in Common October 15, 2013
Question: I’ve heard that people who are more social live longer. Why is that?
Answer: Yes, many studies suggest that staying socially connected predicts greater life expectancy. Being social reduces stress and is helpful in getting care and support from others.
- Online Health Care Insurance Exchanges Debut Oct. 1 September 27, 2013
Question: I’m 68 years old. Should I be shopping for health insurance on the online exchanges?
Answer: No. Seniors 65 and older, and disabled individuals, already meet their insurance requirements through Medicare. In fact, selling marketplace coverage to people who have Medicare is illegal.
- Seniors Increasingly Entering Hospitals Under Observation Care September 26, 2013
Question: My mother was in the hospital for several days and then we had to put her in a nursing home. It turns out that she was never considered an admitted patient while in the hospital. She was considered outpatient under observation care. Because of that, the nursing home is saying we have to pay out of pocket for her nursing home care. How can I fix this?
Answer: You can challenge the observation status. The Center for Medicare Advocacy recommends patients file two kinds of appeals. For more information, read Seniors Increasingly Entering Hospitals As Observation Patients.
You can challenge …
- Support for Alzheimer’s and Other Types of Dementia September 17, 2013
My mom was recently diagnosed with Alzheimer’s disease. Where can I get more information on this disease?