Cheryl Peltekis, RN “The Solutionist”

This week I had to focus my blog on answering a question that I get asked of me over and over by our home health friends. That does not mean that our In-Home Care providers should stop reading. In fact, it means the exact opposite.

Evaluation and Management of the Plan of Care is all about home health managing unskilled care providers that are caring for a complex patient that no longer has a skilled need.

Many home health providers have avoided Evaluation and Management patient types because before the Jimmo settlement patients were denied care because claims were rejected because Medicare said the patient had reached their maximum potential. 

Once CMS had reached a settlement, of the Jimmo Agreement it required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient’s current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.

Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program.

Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.

There are situations in which the patient’s potential for improvement would be a reasonable criterion to consider, such as when the goal of treatment is to restore function. This would always be the goal of treatment in the inpatient rehabilitation facility (IRF) setting, where skilled therapy must be reasonably expected to improve the patient’s functional capacity to be covered by Medicare. 

However, Medicare has long recognized that there may be situations in the SNF, home health, and outpatient therapy settings where, even though no improvement is expected, skilled nursing and/or therapy services to prevent or slow a decline in condition are necessary because of the patient’s special medical complications or the complexity of the needed services.

I am going to be doing a webinar for Medicare Training and Consulting on April 14th and invite all of you to grab a spot if you want to learn how to provide these services and how to use this as a way of building your business.  

Patients that are frequently receiving Evaluation and Management services often have multiple paid caregivers supporting the patients to remain in their home. Learn who could benefit from the services and how you can be a referral partner and grow your business-to-business referrals. 

To sign up for the webinar email Plonsey@aol.com. To learn more on how to grow your agency go to www.homecaresales.com. You can also have a personal tour through our products and services by emailing Mike@homecaresales.com.  

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