3 NEW Medicare Coverage Areas
Medicare is never easy.
Geriatric care providers have historically struggled on behalf of their clients to secure payment for physical, occupational, and speech therapies when there is no improvement to the precipitating condition.
Although it has not been widely advertised, Medicare updated its policy manual early this year (2014) to verify the inclusion of coverage for these types of skilled care – even if improvement is not expected.
This is critical to the well-being of patients suffering from conditions such as Multiple Sclerosis and Parkinson’s disease, because these therapies can prevent further deterioration. These policy revisions are the result of a class-action lawsuit, and will significantly affect countless older recipients – particularly those who wish to prevent the need for institutional care.
Here are a few areas where changes were made…
Physical Therapy
Physical therapy is necessary when medical problems hinder the patient’s ability to move freely or to accomplish everyday tasks. It helps restore or improve physical function and alleviates pain associated with illness. For instance, this type of therapy may help with climbing stairs, getting out of bed, and walking distances.
Physical therapy includes massage, stretching exercises, core exercises, and some weight lifting. Treating therapists will generally assist with these maneuvers and provide the patient with instructions for activities that can be accomplished outside appointments. This treatment is often used during recovery from injuries and post-surgery.
Occupational Therapy
Occupational therapy also assists patients with the fulfillment of daily tasks and activities. It is a holistic, patient-centered practice, which means that it focuses on adapting an environment to meet the needs of the individual (instead of working with the individual to manage in an unfriendly environment).
Care is provided with the assistance necessary to hone motor skills for eating, dressing, driving, and more. Individuals who benefit from this treatment include post-surgery patients, such as those recovering from hip replacements, as well as those who have suffered strokes.
Speech Therapy
As the term implies, speech therapy assists with speech and other communication difficulties, as well as with swallowing. Conditions that often require this treatment include head injury, dementia, Parkinson’s disease, hearing impairment, stroke, and head, neck, and throat cancer.
Speech therapy incorporates the use of flash cards, writing activities, and color coding information.
Coverage Details
If they are eligible for Medicare, people suffering from chronic conditions will now be able to access the care they need to remain in their own homes for as long as necessary – even if improvement is not expected.
These therapies can prevent such conditions from worsening.
When these therapies are ordered by doctors to be provided in either nursing homes or outpatient facilities, patients are subject to various coverage caps. There are exceptions to these caps if medical necessity is confirmed.
Doctors’ orders are also required for home health coverage, and there are no caps involved as long as patients are considered homebound. This doesn’t necessarily mean they must be confined to their beds – these may simply be patients who have considerable difficulty leaving their homes. This may be the case for those who use canes, wheelchairs, walkers, or require the aid of another person.
Because these changes resulted from a class-action lawsuit, the courts ordered that requests for coverage of these therapies denied in the past three years – because the care was to maintain their conditions or because they were not improving – are subject to further review.
So if you need some of these services, it might be time to re-visit your medical practitioner.
Category: Medicare Facts, Tips, and Tricks
