Insurance 101
This is a federal government insurance that is divided into 4 parts: A, B, C, and D.
Medicare
Typically, VA insurance will not cover any medical care post-discharge provided or ordered by who.
Civilians
Therefore, we have to send orders for home health, DME, and medications to the VA MD to order.
If it is a taxing effort for a patient to leave his/her home, this is considered what.
Homebound Status
*Excludes MD appointments, church - Travel must be limited
HMH has a contractual relationship with which DME and Infusion providers.
Gould's and Option Care Health
This is a type of care provided in a nursing home which involves therapy, wound care, IV medications, etc., for a short period of time.
Skilled Nursing Care (Provided in a nursing home, HMH SNF, or a Swing Bed)
*Intermediate Care - Long term, living there
Medicare Part C is called what type of plan.
Medicare Advantage Plan
A refusal form is completed when a veteran decides to what.
Not transfer to the VA hospital.
These insurances cover home health services at 100%.
Medicare, Medicaid, Medicare Advantage Plans
When setting up any DME for a patient, we are required to provide the patient with a what.
List of DME agencies in his/her home area
*And this MUST be documented
Medicare requires what to pay for skilled nursing care.
A 3 Day Qualifying Stay in a Hospital
*3 consecutive midnights meeting medical necessity criteria for hospital care. This is good for 30 days post-DC from the hospital or a SNF stay.
A state government insurance that is often managed by other companies.
Medicaid
Includes Passport, Humana Caresource, Wellcare, Anthem Blue Medicaid, Aetna Better Health
The VA Case Manager can assist with what for the veteran.
Discharge Planning
When a patient has commercial insurance, they may have a what per home health visit.
Copay
Nutritional supplements, like Boost, may be covered by what under specific circumstances.
Insurance
*Typically a commercial insurance. Medicare only covers tube feeding for NPO patients.
These types of insurance require pre-certification for skilled nursing facility care.
Medicare Advantage, Medicaid, Commercial
Active duty or retired military typically have this type of insurance.
Tricare
If a veteran needs Hospice or IV Therapy, typically the veteran has to see who to make those arrangements.
Home health provides these services in the home 1-3 times per week.
Skilled Nursing Services, PT/OT/ST, Medical Social Work, and Nursing Aide
In order to setup home IV therapy or tube feedings, the patient needs what to administer the medication.
Access
IV Meds - PICC/Port
Tube Feeding - Peg or JTube
Medicare covers skilled nursing facility care at this percentage for this number of days.
100% Days 1-20, 80% Days 21-100
*60 midnights facility free, these days start over
*Commercial insurance based on what is approved or not
Any insurance that is not governmental insurance.
Commercial Insurance
This is coverage provided by the VA will for non-VA Provider services.
Fee Based Services
Orders for home health must specific the specific patient need and the MD following the patient for services must complete this form.
Face to Face Form
A DME order must include 8 items. Name them.
Patient Name, Patient DOB, Date of Order, Length of Need, Item Requested, Diagnosis, MD Signature/Date, MD NPI#
If a patient has a diagnosis of mental illness, brain injury, or an intellectual disability, this is necessary for SNF admission.
A 30 Day Exempt Form or PASAR