Show:
Who's Who
Average Daily Census
Partners
Medicare
Home Health
100

Who are Mary Wilson and Jim Simpson

KP Georgia President & KP Executive Medical Director

100

On average how many KP members are in a Skilled Nursing Facility

70

100

Name our Core Hospital Partners

Who is Emory St. Josephs and Emory Midtown

100

When does Medicare cover ambulance transportation?

Medicare Part B (Medical Insurance) covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health.

100

What does Medicare Part A &/or Part B cover in HH?

  • Part-time or intermittent skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Part-time or intermittent home health aide services (personal hands-on care)
200

Who is the VP of the Continuum and her partner the  Associate medical Director

Sally Wingard, RN, MS, GCNS

Martha Wilber, MD

200

On average how many KP members are in Home Health Care?

272

200

What is Apria?

Durable Medical Equipment Vendor

200

Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a SNF in certain conditions for a limited time (on a short-term basis) if all of these conditions are met - List the conditions

  • You have Part A and have days left in your benefit period to use.
  • You have a qualifying hospital stay .
  • Your doctor has decided that you need daily skilled care. It must be given by, or under the supervision of, skilled nursing or therapy staff.
  • You get these skilled services in a SNF that’s certified by Medicare
200

What does Medicare HH not pay for?

Medicare doesn't pay for:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services
  • Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need
300

Who is Sean Stewart

KP Georgia Compliance Officer

300

On average how many KP members are in the hospital

214

300

What are Amedisys, Pruitt Health, Bridgeway & Guardian?

Who are our KP Home Health partners

300

Define Medicare benefit period?

 A benefit period begins the day you're admitted to a  SNF. The benefit period ends when you haven't gotten any skilled care in a SNF for 60 days in a row. If you go into a SNF after one benefit period has ended, a new benefit period begins.  There's no limit to the number of benefit periods.

300

Define Medicare criteria for homebound?

The patient is considered “homebound” under Medicare if the patient cannot leave home without “considerable and taxing effort” . Most patients have an injury or illness that makes it difficult to leave home; for example, if the patient: Requires the aid of supportive devices (wheelchair or walker), needs the assistance of another person

400

Who leads & works to improve our People Pulse scores?

Human resources

QRM Teams

QRM UBT

400

On average how many KP patients are in our case management programs?

592

400

Name KP Core Skilled Nursing facilities?

Who are Pruitt Health Brookhaven, Roselane Health & Rehabilitation, Manor Care Decatur, & Christian City Rehabilitation Center

400

What does Medicare Part B cover?

Part B covers 2 types of services

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best
400

What is the Medicare Criteria for HH? 

What must you meet?

  • You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need, one or more of these:
    • Intermittent skilled nursing care (other than drawing blood)
    • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
  • You must be homebound, and a doctor must certify that you're homebound.
    You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care.
    You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
500

Who is responsible for Work Place Safety

You are!

I'am


500

How may KP patients are in the Continuum Service lines on a daily basis

1,677

500

Effective 1/1/2020 KP will be beginning a  demonstration project for the Department of Defense

TRICARE

500

What is not covered by Medicare Part A & Part B?

Medicare doesn't cover everything. Some of the items and services Medicare doesn't cover include:

  • Long-term care (also called custodial care )
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery  
  • Acupuncture  
  • Hearing aids and exams for fitting them
  • Routine foot care
500

How do we educated a Medicare members if they have a complaint about their care or services?

Contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for complaints about the quality of care you got from a Medicare provider

KePRO

KP Member Services