What Are The Standard Billing and Payment Practices?
When services are covered by Medicare and/or Medicaid, home
care providers must bill their fees directly to the payor
to Medicare or Medicaid. Providers often will bill other
third-party payors directly as well. Any uncovered costs
are later billed to the client. However, if a client receives
services from a registry or independent provider, he or she
must pay the provider directly. Later the client may file
for reimbursement from the insurance company if the services
qualify as covered benefits. Payment options are detailed
below.
Home Health Agencies
Medicare, Medicaid, and most private insurance plans pay for services that home
health agencies deliver. Payment from these sources depends on whether the care
is medically necessary and the individual meets specific coverage criteria. Individuals
may opt to pay out of pocket for services that are not covered by other sources.
Some agencies receive special funding from state and local governments and community
organizations to cover the costs of needed care when other options are not available.
Hospices
Coverage for hospice care is available through Medicare, Medicaid programs in 38
states, and most private insurance plans. If insurance coverage is insufficient
or unavailable, the patient and his or her family may pay for services out of
pocket. Most hospices may provide free services to individuals who have limited
or no financial resources.
Homemaker and Home Care Aide Agencies
Individual consumers usually pay for services from homemaker and HCA agencies.
However, some states contract with these agencies to deliver personal care and
homemaker services within their social services and medical assistance programs.
On rare occasions, commercial insurers may pay for a portion or all of the costs
of these services. Some agencies draw assistance from charitable community funds
when other sources of payment are not available.
Staffing and Private-duty Agencies
Typically, the individual or his or her commercial insurance carrier pays for services
provided by staffing and private-duty agencies, provided that the insurance policy's
coverage requirements are met. Some staffing agencies contract with state Medicaid
programs to provide nursing and personal care services.
Pharmaceutical and Infusion Therapy
Companies
Pharmaceutical and infusion therapy supplies and services are almost always paid
for by commercial insurance companies and Medicaid. Medicare covers the cost of
nutritional supplements and certain medications when the situation meets strict
coverage criteria.
Durable Medical Equipment and Supply
Dealers
Fees for durable medical equipment and supplies are usually covered by Medicare,
Medicaid, and commercial insurance programs, provided that the products are ordered
by a physician and are medically necessary to treat an illness or injury.
Registries
The individual client generally pays for registry services. In some cases, commercial
insurance companies may reimburse a portion or all of these costs.
Independent Providers
Usually the individual pays for services rendered by independent providers. Some
commercial insurance policies will provide reimbursement if the services qualify
as covered benefits. |
