Looking for Information

[dquella]

Hi everyone,

I am a first time poster. I currently work in a case management position that works as a long term care Medicaid program and there is some confusion on my end and I was hoping that you guys could help me out. I am confused on what is covered during a home care Medicare episode. Does Medicare cover skilled nurse visits, wound care supplies, and PT/OT at 100% or do they only cover 80%?

Thanks for the information!

[Libby1987]

Services that meet all criteria are covered 100%, there is never a copay. If all criteria is not met then that is an ABN situation and proper notice is required.

Supplies come out of our episode pay, they're not reimbursed separately, IOW it is beneficial to the agency to be as cost effective as possible and avoid excess and waste.

[dquella]

Excellent! That is what I was thought, but I have had a few home care agencies asking for our program to cover the cost of the supplies.

What exactly is the criteria for wound care? The most recent member had venous stasis ulcers on his legs and stage 3 pressure ulcer on his coccyx.

[Libby1987]

If it still holds, Medicare only covers surgical wound care supplies following home health discharge.

With a Medicare patient we have to provide customary medical supplies even if not the focus of our care but when we discharge their insurance picks up the costs for covered supplies. A home health agency cannot have Medical pay for wound care supplies while providing the home health services but following discharge, then whichever insurance covers the supplies, in the case of stasis or diabetic ulcers and pressure sores, Medical would cover.

Does that make sense?