KEYWORDS
Case Managers/Discharge Planners
Medicare
COP
CMSA
Liability
Negligence
Nonmedical
Skilled service
Patient’s rights
Federal statute
BBA (Balanced Budget Act of 1997)
COP (Conditions of Participation)
CMS (Centers for Medicare and Medicaid Services)
Mileage expense
Expenses
Labor costs
IRS

Fraud and Abuse Compliance: A “Wake-Up Call” for Private Duty Providers

Agencies that provide private duty services only and Medicare-certified home health agencies that also provide private duty services may have erroneously concluded that the fraud and abuse prohibitions that apply to Medicare-certified agencies do not apply to private duty providers.  Recent action against Maxim Healthcare makes it clear that this is not the case.  Maxim is a privately held company with 360 offices nationwide and approximately 88,000 staff members.  While some of these locations are Medicare-certified, Maxim provides services primarily to Medicaid, including Medicaid waiver, patients.  More »

What Case Managers/Discharge Planners Need to Know About Private Duty Home Care Services

In order to be appropriate for home health or hospice services paid for by any payor, including the Medicare Program, patients must either be able to care for themselves or they must have a primary caregiver. Patients’ family members or others may be willing to fulfill this role on a voluntary basis. If not, discharge planners/case managers should offer patients and/or their family members the option to pay privately for a primary caregiver who can meet patients’ needs in between visits from professional staff from home health agencies and hospices. More »

Patients’ Right to Freedom of Choice of Hospices in Hospitals

All providers are required to abide by patients’ right to freedom of choice. There are a number of sources of this right as follows: 1) All patients have a common law right, based upon court decisions, to control the care provided to them, including who renders it. More »

Risk Management in Private Duty Care

Some private duty home care agencies do not provide any skilled services, such as nursing or therapy services. Instead, these agencies may, for example, provide only chore or homemaking services. Private duty home care agencies that do not provide skilled services may describe their services as “nonmedical.” More »

Deliver Best What Your Customers Want Most

If you are like most agency owners/administrators in Home Health, Private Duty and Hospice, you are surrounded by competitors. You are constantly thinking about how to gain market share. You want to differentiate your agency from your competitors so that current AND new customers will be turning to you more frequently. More »