Home Health Payment/Reimbursement Help

  1. Hi,

    We are in the process of setting up a Home Health Company. We have gotten all the guidelines and so forth form medicare and state. We are getting ready to do our budget, but we are having difficulty with the payments/reimbursements.

    So Im hoping someone out there can help me. We've looked into the PPS system and medicare system, but were still confused.

    So, If someone could help me out, i'd greatly appreciate it.

    What is the reimbursement/Payment for a new patients. Say a patient is admitted to your services for diabetes........How many visits, and how much money is to be made?

    What about an infusion therapy patient?
    Ventilator patient?

    Were trying to set up a budget, and say based on 10 patients, how much will we make?

    Thanks for all those that help. You can PM me, post, or email me. Any response will help.

    Thanks,

    bobby
  2. Visit bobnurse profile page

    About bobnurse

    Joined: Sep '04; Posts: 476; Likes: 32

    2 Comments

  3. by   suzanne4
    Quote from bobnurse
    Hi,

    We are in the process of setting up a Home Health Company. We have gotten all the guidelines and so forth form medicare and state. We are getting ready to do our budget, but we are having difficulty with the payments/reimbursements.

    So Im hoping someone out there can help me. We've looked into the PPS system and medicare system, but were still confused.

    So, If someone could help me out, i'd greatly appreciate it.

    What is the reimbursement/Payment for a new patients. Say a patient is admitted to your services for diabetes........How many visits, and how much money is to be made?

    What about an infusion therapy patient?
    Ventilator patient?

    Were trying to set up a budget, and say based on 10 patients, how much will we make?

    Thanks for all those that help. You can PM me, post, or email me. Any response will help.

    Thanks,

    bobby
    Which state are you in and what type of patients will you be accepting?
    You also must take into account how long that it will be before you receive the funds. It is not going to be like you were working per diem and the agency was paying you right away. It can be anywhere from 60 days or so on average, 40 or so if you are really lucky. If you are not doing the work yourself, but will have employees, you need to take this in to account.

    Daibetes patients normally have to see at least a CDE, Certified Diabetic Educator in order to be able to bill for the services. Just seeing an RN for teaching has not been accepted in the past for payment.

    Ventilator patients can be billed per hour for the shift, or per visit. Depends on what they actually have approval for..............

    Since rates will vary by state, etc. best suggestion that I have is to speak with one of the case managers at a hospital that you currently go to........

    Hope that this helps..................
    Last edit by suzanne4 on Apr 25, '05
  4. by   KLQ727
    If you're setting up an intermittent visits - home health care company as opposed to providing private duty shift care in the home....

    Reimbursement under medicare (PPS) basically is now based on an episode payment.

    In a quick nut shell... (and it's way more complex than this!!!) Doctor gives you a referral....
    Nurse makes 1st visit and fills out the OASIS (PPS document with MANY questions). Based on the answers to these questions which include the primary skilled care diagnosis for the home care visits, and many answers about the patient's abilities to care for himself, you will receive a specific rate for reimbursement for a 60 day episode of care. (The answers are numerically weighted and add up to a HHRG which equates to a dollar amount for your geographic location.)

    This reimbursement comes in 2 lump sum payments, and covers ALL (visits) care you provide for that patient (Nurse, Aide, MSW, PT, OT,ST) for the 60 day period. In several instances, it also covers any supplies such as dressings, ostomy supplies, etc. that you provide for the patient.

    Medicare no longer pays per each visit made. (Yes, there is an exception...if you make less than 5 visits they will pay for each visit.)

    But say you have a patient who needs to be seen daily....they can lose money for you....but the catch 22 is you have to accept some of them or risk being banned from accepting medicare payments.

    Each case will be different. Some patients can conceiveably make you a profit, and others will possibly eat up the profits.

    Home health is a rewarding industry, but you won't get rich in $$$$.

    For more information see:
    http://housecalls-online.com
    http://homehealth101.com

    Hope this helps.

close