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Medicare update: New homecare requirement

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Beginning next month, Medicare beneficiaries receiving care at home must prove that they actually require the service in order to receive coverage for it. While this requirement may sound reasonable, home health agencies and consumer groups are describing it as overly burdensome for frail seniors or those who live in rural areas without easy access to health care.

The new rule requires that a doctor or other health care provider certify that he or she has personally seen the patient and that the patient is in need of home health care. Because of the potential for confusion among health care providers regarding such things as proper documentation, the AARP, for one, is taking a hostile stance toward the new rule. AARP lobbyist Nora Super complained that “patients may lose access to their care” as a result of confusion and delays.

The new rule, which aims to control unnecessary Medicare spending as well as outright fraud, requires Medicare beneficiaries to see a doctor sometime during the period 90 days before and 30 days after beginning care in order for the homecare agency to received reimbursement. Homecare groups are calling for implementation of the rule to be delayed until June.

The current rule does require that a doctor prescribe homecare before reimbursement is made, however, patients do not have to be seen. Some Medicare experts disagree that the new regulation is too onerous and argue that it does not go far enough to reduce waste and fraud because it allows too much time to prove the need for homecare, one of the Medicare’s fastest rising expenses.