101: Learn To Boost Private Duty Homecare Revenue Billing Medicare Advantage

101: Learn To Boost Private Duty Revenue Billing Medicare Advantage
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Private Duty In-Home Non Medical home care provides support to seniors so they can remain living at home. These companies provide an invaluable service that supports the collaborative effort to keep patients out of the hospital and help lower the hospital readmission rate which is a goal started by the Affordable Care Act in 2015 ( ) to reduce medical spending on a National level.

Until now, services for ADL’s (activities of daily living) were paid out of pocket for caregivers to help with dressing, eating and other personal care needs and the majority of those in need are low income Seniors who just cannot afford to pay for assistance.

According to a 2012 survey by AARP, about 90% of people 60 or older plan to live in their current homes for the next five to ten years. This is a phenomenon AARP calls “aging in place.” However, as many people experience declining health, they may want in-home caregiving to help with medical needs, household functions, and personal care. CMS (Center for Medicare and Medicaid) has finally taken notice and now allows Medicare Advantage Plans to reimburse companies for private duty services.

Seema Verma, the Administrator of CMS stated, “For the first time ever, Medicare Advantage beneficiaries can access significant new flexibility for additional benefits that can help them live healthier, more independent lives. [MA] plans can offer benefits [beginning in 2019] that compensate for physical impairments, diminish the impact of injuries or health conditions, or reduced avoidable emergency room utilization. This means Medicare Advantage beneficiaries will be provided adult day care services, respite care for caregivers, and in-home assistance with activities like bathing and managing medications.

According to AARP, only 3% of the more than 3000 Medicare Advantage Plans will offer this private duty benefit in their policies in 2019. “The slow uptake of new supplemental benefits in 2019 is hardly surprising. That’s because CMS announced MA plans’ new flexibility just a few months before insurers were due to finalize their plan offerings for next year—giving them little time to adjust benefit packages. MA benefits could look very different in 2020, when insurers will also be implementing new rules for supplemental benefits that were written into the Bipartisan Budget Act of 2018 .”

Common Questions Asked By In-Home Non Medicare Private Duty Companies:
1. What is Medicare Advantage – Is it Medicare?
2. Do clients/patients need Medicare to receive the caregiver benefit?
3. How do I find insurance in my area that is offering this supplemental plan?
4. How does an In-home private duty company become eligible to submit claims for the services they provide?
5. What does the future hold?

Seema Verma, The Administrator of CMS stated, “Our priority is to ensure our Seniors have more choices and lower premiums in their Medicare health and drug plans. We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits.”

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