Tuesday, September 20, 2011

A Personal Update and Some Thoughts

Thelma and I just returned from a brief holiday in Sonoma County, Calif. I did not bring my computer and so I saw no emails for a week. That in itself was refreshing. It allowed me to keep an open mind to think about our industry, our profession and our future.

Home Health Care! No matter what it is called, our industry provides home health care. The products, the equipment, and, even more important, is the service that HME providers give to their clients, customers and family caregivers. This is far in excess of any reimbursements they obtain.

Why are CMS and Congress working so hard to reduce them? I am in complete agreement with them that the cost of this service has skyrocketed. But what I see, when I study it, is that they can correct what has been created very simply. The reimbursements are not as much we should to receive. Are there sufficient profit dollars received to maintain their company? A fair payment for a service or a product has l always been the American way.

I said a fair reimbursement! THIS IS WHERE THE PROBLEM BEGINS. It appears that there are no controls, no simple way of checking because the provider uses a HCPS number. How often is a number with a larger reimbursement utilized? I spoke to many acquaintances asking if they checked the reports each month showing how much and what was paid for. They had no idea, only saw the amount billed and how much was paid.

When CMS sends a Medicare Summary Notice, it indicates date, provider, service, amount billed and what Medicare approved. Then they receive an explanation from their supplemental insurance, which also indicates how much Medicare paid, then what the supplement covered. Basically, it is good system, but the problem is that very few people really look at these or only if they may be billed.

I spoke to about a dozen friends my age and they all said: “ why should I?” As long as they do not have to send any money they were satisfied. This is something every beneficiary should review!

I have written often about fraud and abuse. As far as I can see this is probably adding another layer of perhaps as much as 40% additional to the cost. This, too, must be determined! I am sure you realize that with standards, and a licensure program to eliminate thievery, this will be addressed.

All I am trying to say is it is time to show CMS and congress how little we are paid for the services provided. Without controls far to many ”fictional” companies will continue to submit bills and get paid. When they are caught, is the money recovered, do they go to jail or what happens to them?

There should be more awareness developed so every recipient will know how much was paid on their behalf and was that correct. We must get everyone of our customers and family caregivers involved and a great deal of chicanery can be eliminated so they will not lose this important service.

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