Medicare Changes Effect Patients in Scranton

Interim HealthCare Blogs
Posted: 10/30/2013 12:00 AM by Interim HealthCare
In the past, seniors who received physical therapy had to show improvement or Medicare would stop paying for treatment. If they got worse, Medicare would then pay for additional therapy. The same rules applied other types of killed care such as nursing, speech therapy and others. But here lies the problem, many seniors reach a plateau or level where improvement stops but care is still needed to maintain current levels that give them an acceptable quality of life. Under the old rules, this was not paid for and seniors would begin to deteriorate until such time as Medicare would once again pay for the needed services.

This created unnecessary pain and discomfort for patients and was shown to be more expensive than simply paying for care that maintained acceptable levels without showing additional improvement. 
A recent lawsuit forced Medicare to change this policy immediately. The new policy applies to care by skilled professionals in outpatient therapy, home health care and nursing homes. Here’s the rub, the lawsuit doesn’t require that Medicare inform anyone of this until next January, including their own employees. This means that many doctors and therapists don’t know about this change and don’t seem to be able to find out by calling the Medicare information line.

The bottom line is this: If continued treatment is required, even past the standard dollar limit, medical professionals can put a code on the claim that states further treatment is medically necessary. If your providers say your coverage will come to an end, make sure to inform them about this very important change.

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