Medicare Guidance for SLP Services in Skilled Nursing Facilities (SNFs)
Resistance to ordering videofluoroscopic or FEES studies for Part A patients may arise because the cost of the procedure (and transportation) is paid by the SNF out of the patient’s per diem rate (called Consolidated Billing). The SLP must clearly justify the need for an instrumental assessment to identify the cause and severity of dysphagia, not only to identify possible aspiration risk and appropriate texture, but to identify effective compensatory strategies or treatment techniques that would be incorporated in the Plan of Care. In some cases, instrumental studies may not be warranted if clinical indicators suggest that the study is not likely to provide beneficial information (see ASHA document Clinical Indicators for Instrumental Assessment). Instrumental studies can potentially save money by preventing patients from being placed on unnecessarily restrictive diets or alternative feedings (Martin-Harris & Logemann, 2000, Clinical utility of the modified barium swallow. Dysphagia, 141, 136–141.) (Note that in most states an in-house FEES procedure requires a physician, nurse practitioner, physician assistant, or clinical nurse specialist to be immediately available.)
Medicare Coverage Guidelines
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Guidelines and Recommendations
A national coalition consisting of healthcare professionals and patients with end stage renal disease (ESRD) was formed in 2005 to increase the rate of hepatitis B, influenza, and pneumococcal immunizations in patients and staff in the dialysis setting.
Medicare Coverage of Speech
This area of the Reimbursement site provides information on the major aspects of Medicare related to audiology and speech-language pathology services, including Medicare coverage guidelines and reimbursement rates.
Medicare Home Health Guidelines
1. The need for homecare services must be for treatment of an illness or injury and require the skills of a nurse or therapist with specialized knowledge and training not expected from non-medical individuals. 2. The patient’s condition must be such that the services of the nurse/therapist are expected to support the patient’s ability to achieve individual treatment goals. 3. Nursing services are recognized for the purposes of teaching and training, direct care, and/or assessment and observation. 4. Therapy services, in general, must be based on the presence of functional goals that would be unlikely for the patient to achieve without skilled therapy.
Medicare Information, Help, and Plan Enrollment
Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Plan Formulary may change at any time. You will receive notice when necessary. Benefits, premiums, and/or co-payments and/ or co-insurance may change on January 1 of each year.
Medicare Insurance Guidelines
Both Medicare and private health insurance plans pay for a large portion or sometimes even all costs associated with many types of medical equipment used in the home. This type of equipment is referred to as durable medical equipment or home medical equipment. The guide below will help you understand the Medicare guidelines related to home medical equipment. Most health insurance plans have similar rules to Medicare, but you should know that all private health insurance plans vary and the specific rules of your plan may differ from these Medicare guidelines. We accept most of the major health insurance plans. We would be happy to work with you and your insurance company to help you understand how your plan works as it relates to home medical equipment needed by yoBoth Medicare and private health insurance plans pay for a large portion or sometimes even all costs associated with many types of medical equipment used in the home. This type of equipment is referred to as durable medical equipment or home medical equipment. The guide below will help you understand the Medicare guidelines related to home medical equipment. Most health insurance plans have similar rules to Medicare, but you should know that all private health insurance plans vary and the specific rules of your plan may differ from these Medicare guidelines. We accept most of the major health insurance plans. We would be happy to work with you and your insurance company to help you understand how your plan works as it relates to home medical equipment needed by you or a loved one.
Medicare CoPs and Interpretive Guidelines
Medicare interpretive guidelines are used by sate survey agencies (also known as SAs, which are usually state departments of health) to ascertain healthcare facilities’ compliance with the CoP. Such SAs survey healthcare facilities on two conditions: to determine the facility’s eligibility to participate in the Medicare program if it is not otherwise accredited by a “deemed status” entity such as the Joint Commission on the Accreditation of Hospital Organizations (JCAHO), and to audit healthcare facilities already accredited. According to the Government Accountability Office (GAO), SAs survey about 5 percent of a state’s hospitals in a given year. Medicare has provided SAs such interpretive guidelines for many years; however, CMS’ action to publish them online in May 2004 has brought increased scrutiny to the guidelines by AANA, CRNAs and hospitals. The importance of the interpretive guidelines to CRNAs is that at a practical level SA surveyors use them to ascertain facilities’ compliance with the CoP. Interpretive guidelines are identified either by the citation of their respective CoP in the Code of Federal Regulations, or by their heading or “Tag” number under which they appear in their respective CMS manual or appendix.
ConnectiCare Physician & Provider Manual
ConnectiCare follows CMS guidelines for codes that are subject to multiple procedure reduction as indicated in the Physician Relative Value Unit file at www.cms.gov. See Medicare Status Codes discussed earlier in this section. Diagnostic Imaging Code Families: Effective August 15, 2013, the 11 diagnostic imaging code families under the Multiple Procedure Payment Reduction on the Technical Component will be consolidated into a single family. This consolidation of imaging code families is consistent with CMS’ January 1, 2011, guidelines, please refer to
Rhode Island Division of Elderly Affairs: Programs
Medicare is the nation’s health insurance program for people 65 and older, and younger people who are disabled or who have end stage renal disease. Medicare consists of four parts–Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Insurance Plans) and MedicarePart D (Medicare Prescription Drug Plans). Almost all persons over age 65 are automatically entitled to Medicare Part A if they or their spouse are eligible for Social Security or Railroad Retirement.