Home aid care reimbursement for veterans

I was talking to the coordinator who facilitate the home care aid reimbursement (home care or in a facility) for California veterans/spouse of veterans and that the family member  must reach out to us for info. Must have hired a home care aid first before the reimbursement process starts. The family member is best to coordinate since parents might have cognitive decline and must be internet savvy to go thru the needed documentation.

Connie Dello Buono

President

Motherhealth LLC , home care organization agency

408-854-1883

 

card mother

California Telemedicine Policy

With its first telemedicine parity laws passed in 1996, California has a long history in telemedicine reimbursement and was one of the first states to acknowledge the value of telemedicine.

Like many other U.S. states, California recognizes how important telemedicine is improving healthcare access for patients challenged by distance or mobility.  Pending legislation in California illustrates a movement toward utilizing telemedicine as a way to reach those with special needs and those in need of behavioral health care services.

Parity Law

Yes. California has a telemedicine parity law mandating private payer reimbursement for telemedicine.

Type of Telemedicine Covered

California’s Medicaid program covers live video telemedicine. The state also covers store-and-forward services for Teledermatology, teledentistry, and teleophthalmology.

Covered Health Services

California reimburses for wide variety of evaluative & management health services, and psychiatric services. Check out our Billing Codes section below for more details.

Billing Codes

 

CPT E&M Codess

  • 99201 – 99215 Office or other outpatient visit (new or established patient)
  • 99221 – 99233 Initial hospital care or subsequent hospital care (new or established patient)
  • 99241 – 99275 Consultations:  Office or other outpatient, initial or follow-up inpatient, and confirmatory

CPT Psychiatric Codes

  • 90785 Interactive complexity 90791 Psychiatric diagnostic evaluation
  • 90792 Psychiatric diagnostic evaluation with medical services
  • 90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
  • 90832 Psychotherapy, 30 minutes with patient and/or family member
  • 90837 Psychotherapy, 60 minutes with patient and/or family member
  • 90839 Psychotherapy for crisis; first 60 minutes
  • 90840 Additional 30 minutes
  • Telehealth originating site facility fee : Q3014 (Once per day, same recipient & provider)
  • Transmission costs for telehealth services via audio/video communication: T1014
  • (Maximum of 90 minutes per day same recipient, same provider)
  • Plus, make sure you use the GT modifier with your CPT code to indicate live video telemedicine. If you’re using a store-and-forward solution, use the GQ modifier.

 

Eligible Healthcare Providers

Medi-Cal does limit which healthcare providers can get reimbursed for telemedicine. Here’s who qualifies:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Registered dietitians or nutrition professionals
  • Nurse midwives
  • Certified registered nurse anesthetists
  • Clinical psychologists
  • Clinical social workers

Online Prescriptions

Providers are prohibited from prescribing or dispensing dangerous drugs or dangerous devices on the Internet without an appropriate prior examination and medical indication.

Informed Patient Consent

Yes. Providers need to get patients’ oral consent before they can start a telemedicine service. Providers also need to document consent in the patient’s medical record.

Cross-State Telemedicine Licensing

There’s no interstate licensing available for California right now. Providers doing telemedicine in California need to have a California license.

Restrictions on Locations

Medi-Cal has no limitations on where the patient or provider has to be during the telemedicine visit. That makes it easy for providers to offer quick, convenient virtual care – and get paid for it.

Other Reimbursable Fees

Medi-Cal reimburses the originating site a facility fee, and pays the originating and distant sites for live video transmission costs.

Reimbursement Rates

Good news! California Medicaid reimburses telemedicine services according to the current physician fee schedule amount for that medical service. So reimbursement rates for a telemedicine service should be the same as the comparable in-person medical service.

Helpful Resources

  • California Telehealth Resource Center
  • Center for Connected Health Policy
  • American Telemedicine Association State Policy Matrix
  • University of California Davis Center for Health and Technology
  • California Office of Health Information Integrity — eHealth (CalOHII)
  • The Medical Board of California: Practicing Medicine Through Telehealth Technology
  • Centers for Medicare and Medicaid Services: Telemedicine
  • ————-

Dear Readers,

We are inviting doctors and investors to join us in a telemedicine health application, being developed by Motherhealth to fill in the gaps in the current mobile health apps.

Email motherhealth@gmail.com to join.

Regards,

Connie Dello Buono

http://www.motherhealth.net

San Jose CA 95124

Hospital costs in the USA

Assessment of Cost Trends and Price Differences for U. S. Hospitals March 2011

Margaret E. Guerin-Calvert, Vice Chairman and Senior Managing Director, Guillermo Israilevich, Vice President

ASSESSMENT OF COST DRIVERS AND TRENDS IN HEALTHCARE AND THE HOSPITAL SECTOR

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Hospital care accounts for a steady proportion of national expenditures on healthcare, approximately 30%, and is projected to remain at this proportion for the next decade. Over the past decade, increased expenditures on labor explain a substantial proportion of overall cost increases experienced by hospitals. In addition, hospitals are facing a growing need to cover shortfalls from insufficient Medicare and Medicaid reimbursement, uncompensated and charity care, and new compliance-related costs for new technologies such as electronic health records. Moreover, reimbursement shortfalls have increased in significance with the increasing proportion of inpatient admissions from Medicare and Medicaid. Overall, hospital revenues have closely tracked cost increases at the national and regional level. This indicates that, on average, hospital margins have not increased substantially.

SPENDING ON HOSPITAL CARE IN THE CONTEXT OF OVERALL HEALTHCARE EXPENDITURES

A useful starting point for evaluating cost trends for hospitals is to put them in the context of broader healthcare costs and trends. Hospital services are one aspect of healthcare expenditures.9 As the following table shows, there are many different expenditure categories accounting for total national healthcare costs.10 As of 2009, healthcare expenditures accounted for 17.6% of the Gross Domestic Product (GDP). Of a total of $2,486 billion in expenditures on healthcare at the national level in 2009, hospital care accounts for $759 billion, or 30.5%. Other major categories include professional services, including physician and clinical services (27.1%), prescription drugs and other medical products (13.2%), nursing home and home health (8.3%), and investment (6.3%).

 

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ACUTE CARE HOSPITAL COSTS IN MASSACHUSETTS (FY 2004 TO FY 2008)


Connie’s comments: Hospitals are burdened by Medicare and Medicaid patients and so must compensate for loses. We like that nurses pay increased in some parts of the states. Drug costs and high tech hospital equipment still account for the bigger expense.

We have to ask hospital management. Medicare and Medicaid reimbursements, expensive equipment, labor, and other services add up to hospital costs. They want to stay on the black and not red but more patients come in due to obesity, alcohol, drugs, and tobacco use. About 25% of the expenses are related to the aging population. We can save money if we are all healthy with no addiction to drugs, alcohol, tobacco and sugar.