Corinthians of Nevada Health care Inc., yet another Home health company out to milk Medicare for all it's worth at the expense of the patients! Corinthians has the same class of people in its administration and managerial ranks (which happen to be all Filipino). Mr. Reddy who is listed on the Secretary Of State website as the President/Owner refers to himself as the Medical Director which anyone who is familiar with the State of Nevada Licensing; Certification requirements for Home Health recognize it as a serious violation as he is NOT A PHYSICIAN. The so called Director of Nursing Angel does NOT contain the credentials as a Public Health Nurse and does not have the appropriate education equivalents that Nursing students would be required to complete in the United States (check Nursing Board records). The woman named Grace; is an uneducated business administration failure and not a nurse but calls herself the Administrator. Once again Medicare regulation and State Licensing and Certification guidelines require that the Home Health Administrator must be a supervising Public Health Nurse in the role of Director or Nursing or a Physician in the role of a Medical Director. Corinthians is also plagued with an individual named Anita whose only apparent gift is malicious gossip and mediocrity at her role as the staff scheduler. This company demonstrated a consistent pattern of habitual liars amongst its staff, they failed to coordinate the staffing for physician ordered services, for what limited staff was provided they provided many incompetent nurses who have no business being in that profession and routinely failed to issue the proper HHABN forms each time they Denied, Reduced and later Terminated Home Health benefits. This company ultimately abandoned an elderly bed bound patient with multiple skilled needs without the proper notification and were faulted by the QIO per the findings of an Independent Physician Reviewer which is now forwarded to the Bureau of Health Care Quality and Compliance, the Office of the Inspector General and the Survey & Certification unit of the Centers For Medicare and Medicaid Services (Region IX). Despite followup contact by the QIO this Home Health company REFUSED to continue to provide NECESSARY SKILLED CARE DESPITE THE NON EXISTENCE OF ANOTHER HOME HEALTH COMPANY. Mr. Reddy the fraud who claims himself to be the Medical Director and through his daughter Red (calls herself the Office Manager) intentionally contravenedf Medicare regulations and the QIO's determination that Home Health Services were to continue by intially indicating they would provide Skilled Nursing as ordered by the QIO but on the date of the scheduled appointment committed a no show and later advised us via our telephone call to the office manager "My father (MR. REDDY) indicates we are NOT BOUND to continue to provide any further Home Health Services to the patient because WE DO NOT ACCEPT MEDICARE ASSIGNMENT!"
The only nurse who demonstrates on the job competence as it relates to the skillset she states to possess was Ana Manzo, R.N. Ana has an extensive background in the hospital environment as a Wound Care, IV/PICC line, Critical Care Nurse. Ana, however, is a moneymaker and therefore she is not loyal to any patient. When it comes down to Nursing Quality only Ana demonstrated proper skill and excellence, all other nurses (Melonie, Kate, Cathy, Giggie, Katie) were professionally incompetent and sloppy. Home Health Agencies, specifically the Director or Nursing are charged under the state certification requirements to ensure that appropriate nursing staff are dispatched possessing the proper skill set to deal with the complex medical care of the patient to which they are assigned. A nurse who knowingly accepts assignment knowing they have not the experience or skill to properly address a skilled task is also in violation of the Nurse Practices Act (NRS 629).in addition (NAC 632.890 (4) reads;"Nurses and CNAs may be disciplined if they accept assignments they are not competent to perform. If they do, they may place the patient in danger, assuming duties and responsibilities within the practice of nursing if competency is not maintained, or the standards of competence are not satisfied, or both are in violation of the Nurse Practice Act." Here the issue was improper care of a nephrostomy tube and the utilization of the improper stat lock stabilization device/dressing designed for a urethral catheter and not the smaller nephrostomy tube (which requires a different statlock).in addition the nurses demonstrated improper sanitation techniques and contributed to the dislodging of the position of a nephrostomy tube by aggressively pulling off the stat-lock device dressing while not securing or holding the nephrostomy tube. Some of the nurses would also touch their noses or other parts of the body and expose and touch the wound sites and fail to sanitize the area before reapplying any dressings. The nurses also would fail to report signs of discharge, swelling, redness or strong odors to any physician.in this matter the patient developed an additional urinary infection due of the dislodging of the nephrostomy tube and partial urinary obstruction that they caused. The Patient went for an emergency procedure for a nephrostomy tube change at Sunrise Hospital as ordered by the Urologist. The patient is an 79-year-old elderly patient who is total care and such incompetent practice of nursing that can jeopardize the patients life should never be tolerated. The patient suffered extensively with pain as a result. It is very appalling that Mr. Reddy (Owner/President) of Corinthians of Nevada Health Care response to the poor quality and dangerous incompetence of his Nurses was "Almost all of my Nurses are either Nurse Practitioners or Doctors in the Philippines. "The fact of the matter is that anyone that is familiar with the former open door policy of the United States toward the Philippines is aware that educational and practical application of nursing in the Philippines is considerably substandard compared to what the Nursing students in the United States (or Nurses from other countries coming to the USA for that matter) must complete to earn their full credentials for licensure as a nursing medical professional. A clear example is the so called Doctors or Nurse Practitioners Of the Philippines who more often than not refuse to complete hospital internships or additional educational or clinical/training requirements in the United States and elect to reduce themselves to operating as Registered Nurses instead. This Home health Company also failed to provide any supplies (other than 2 incorrect stat lock stabilization devices), failed to provide wound care for peg tube site or pressure sores on buttocks, failed to report signs and symptoms of pain/infection, swelling, redness, discharge and failed to address an uncontrolled blood glucose and PTINR situation.
This company is among several in the area which ironically all happen to be owned or managed by Filipinos who DENY Home Health Aide (CNA) services to patients that require them. The business plan of Corinthians is to keep a larger slice of the Home Health Episodic Package, specifically the block of money that Medicare would pay for medically appropriate and necessary services (as ordered by the Patients Physician) that is meant to cover Skilled Nursing, Home Health Aide (CNA), Physical and Occupation and Speech Language Pathology services. Corinthians in the same spirit and manner as Orosay Home Health, Five Star Home health, Apple Home Health, Vision Home Health, Familycare Home Health, Excell Home Health, Nightingale Home Health, Oasis Home Health, Saguaro Home Health and VIP Home Health CONSISTENTLY UNDERPROVIDE HOME HEALTH AIDE (CNA) SERVICES, DENY CNA ON ACCOUNT OF THE PRESENCE OF A PCA OR BULLY THE PATIENT AND COORDINATE THE SECURING OF PERSONAL CARE ATTENDANT'S VIA NEVADA MEDICAID (OR A WAIVER PROGRAM) AND THEREAFTER DISCONTINUE THE CNA DESPITE THE LEVEL OR CARE NEEDS OF THE PATIENT OR THE PHYSICIANS ORDERS. These companies all share the habit of failing to adhere to Medicare Conditions of Participation that require them to issue the properly completed HHABN (Home Health Advance Beneficiary Notice) at EVERY ACTION WHERE A SERVICE IS DENIED, REDUCED OR TERMINATED. Corinthians seems to enjoy abusing the patient's/beneficiary rights and should you have familiarity with the regulations and survey and certification requirements they label you a troublemaker and begin a defamatory and discharge campaign.
MEDICARE guidelines are very clear and have a precise definition of what they consider Skilled Nursing and Home Health Aide with emphasis on the educational and experience credentials required. A Personcal Care Attendant or PCA is a non medical person authorized to perform tasks related to Activities of Daily Living and Independent Activities of Daily Living. These contain tasks such as bathing, dressing, grooming, light housekeeping, cooking, laundry, shopping etc. A PCA as defined in the Medicaid Service Manuals (Chapter 3500 State Plan Option, Chapter 2200 Frail Elderly (Chips) and Chapter 2300 WIN (Physically Disabled Waiver) outline in detail the NON MEDICAL DUTIES of a Personal Care Attendant and specifically states what a PCA MAY NEVER DO. Those interested in this subject compare the functions of the PCA with those of the Certified Nursing Assistant (Home Health Aide) in Chapter 7 and Chapter 15 of the Benefit Policy Manuals for MEDICARE. You may also look at the Nevada State Board of Nursing (or your states nursing board) website to find a list of CNA authorized functions as allowed under state law. What you will discover is there are SUBSTANTIAL NUMBER OF TASKS that a Certified Nursing Assistant (Medicare calls them Home Health Aides) is allowed to perform in the state of Nevada on behalf of a patient that a PCA is NEVER ALLOWED TO PERFORM. Corinthians much like those other HHA (Home health Agency) listed above like to deceive patients into believing that a CNA and PCA are the EXACT SAME THING and you may NOT have BOTH. Well as it is elaborated in Health Insurance Manual 11 (Benefits Policy Manuals Chapters 7, In addition see Chapter 15) Medicare doesn't pay for Long Term Care or Custodial Care, meaning care that only appropriates coverage for ADL's and IADL's (also referred to as Incidental Services to the Home Health Aide), BECAUSE it SPECIFICALLY REQUIRES that the CNA PERFORM HEALTH RELATED SERVICES. PCA's are not directly supervised by a Registered Nurse nor do they report to them, they do not take vitals (TPR, BP, apical, brachial and radial pulses, oral, axillary and rectal temps, use of automatic vital signs devices, respirations, tympanic temperatures), cannot do simple dressing changes, cannot obtain clean catch urine specimens, stool or sputum specimens, cannot perform Active Range Of Motion or Massage, Skin care (involving prescribed treatments), apply prosthetic devices, immobilizers, braces, splints and orthotics onto contracture or functionally impaired patients, Position and provide comfort measuressupine, prone, side-lying, Fowlers and Sims positions, transport of a patient via gurney, administer enemas, digital stimulation, apply oxymetry, adjust oxygen flow rate, utilize infection control protocols, assist with proper transfer technique and ambulation of the complex total care patient, perform suction and oral care to the stroke patient, Observing, reporting and recording changes in condition, abnormal signs and symptoms and report to Registered Nurse.
These HHA also like to offload responsibility on the family or people they document and speculate are around the patient. As is noted HIM-11, Section 203.2 (HIM-11 is Chapter 7 Home Health Benefit Policy Manual) The patient is entitled to have the cost of reasonable and necessary home health services reimbursed by Medicare regardless of whether or not there is someone else available in the home to furnish them unless the family or another caregiver is or will be providing services that ADEQUATELY MEET THE PATIENT'S NEEDS. Therefore, where family members are available and able to assist but are UNWILLING, the services would be covered if they meet coverage criteria. Many non medical family caregivers feel very uncomfortable with performing specific skilled tasks for their loved ones and Medicare DOESNOT REQUIRE MANDATORY OBLIGATION on them to provide the service irrespective or whether or not they may have observed or teaching attempts were made. Furthermore, whether or not a patient is receiving PCA services (which are considered custodial care by Medicare) via a Medicaid State Plan or Waiver Program, or who has Third Party Insurance (or whose family pays out of pocket) for additional (referred to as SUPPLEMENTAL SERVICES) whether from a Nurse or not, whether it be for Respite care or not, where the provided services are according to the unique medical condition and level of care needs of the patient, and it is done at other times where the home health Agency's staff is not on duty providing for that care or is delegated only partial tasks of the overall health related care the patient requires, DOES NOT INTERFERE OR PREVENT PAYMENT OF MEDICALLY REASONABLE AND NECESSARY SERVICES ORDERED BY THE PHYSICIAN.
Medicare's Benefits Policy Manual Chapter 7 HIM-11, Section 203.2 states Medicare payment should be made for reasonable and necessary home health services where the patient is also receiving supplemental services that do not meet Medicare's definition of skilled nursing care or home health aide services.
60.10 Impact of Other Available Caregivers and Other Available Coverage
Medicare Benefit Policy Manual (CMS Pub. 100-2, Ch. 7 20.2)
Whether there is a caregiver available in the home to provide services to the beneficiary usually does not affect the eligibility for Medicare covered home health services. Likewise, the eligibility for reasonable and necessary home health services is not affected by the fact the beneficiary may qualify for care in another setting (e.G., hospital, skilled nursing facility).in addition, the eligibility for reasonable and necessary home health services is not affected by any supplemental services the beneficiary may receive that do not meet Medicare's definition of skilled nursing care or home health aide services (example non medical custodial care or respite care at night).
Corinthians Of Nevada Health Care, operates in the same manner as those other Home Health Agencies listed above, their specialty being Medicare Fraud, the pursuit of getting rich at the expense of substandard and limited patient care. Many of you who find this review will no doubt have ran into a situation where you may have been told someone does Not qualify for or skilled services or frequencies are being reduced or are ultimately DISCHARGED from Home Health on account of a condition being CHRONIC or requiring Long-term/Custodial Care that ALLEGEDLY Medicare DOES NOT COVER. First off any task that is defined as a Skilled Care task that a Nurse is responsible for performing under the Medicare regulations and State Nurse Practices Act (NRS 629 in Nevada) can be REFUSED TO BE PERFORMED BY any family caregiver that happens to be around the incapacitated or disabled patient that is unable to perform the tasks for themselves. This situation constitutes the patients medical care needs not being adequately met and thereby would be covered by medicare through the home health benefit. Furthermore as we have already discussed above CUSTODIAL CARE IS NOT SKILLED CARE but rathe care in the performing of personal care services such as Activities Of Daily Living and Independent Activities Of Daily Living. Let's look at some Medicare regulations that further explain the truth and coverage guidelines in this matter:
HIM-11, Section 205.1A (4) and 205.2A (5) (c) The determination of whether a patient needs skilled nursing care should be based solely upon the beneficiary's unique condition and individual needs, without regard to whether the illness or injury is acute, chronic, terminal or expected to extend over a long period of time. Therapy services are covered if: the condition of the patient will improve materially or services are NECESSARY TO ESTABLISH A SAFE AND EFFECTIVE MAINTENANCE PROGRAM.
HIM-11, Section 205.1A (4) The nature of the service rather than the duration of the service is the determining factor in deciding if care is covered. Skilled and personal care services will be covered provided that the coverage criteria are met despite the fact that they may be necessary for a long period of time.
HIM-11, Section 203.1A, 203.3,205.1A (7) Coverage determinations may not be made based solely on general inferences about patients with similar diagnoses, on data related to utilization in general or on treatment norms, but must be based on the specific patient's individual needs.
Another bit of insight these conartist Home health Agencies lack is the guidelines as it relates to max Home Health benefits that can be provided to the patient as ordered by the Physician:
30 - Conditions Patient Must Meet to Qualify for Coverage of Home Health Services
(Rev. 1,10-01-03)
A3-3117, hha-204, a-98-49
To qualify for the Medicare home health benefit, under 1814 (a) (2) (C) and 1835 (a) (2) (A) of the
Act, a Medicare beneficiary must meet the following requirements:
Be confined to the home;
Under the care of a physician;
Receiving services under a plan of care established and periodically reviewed by a physician;
Be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology; or
Have a continuing need for occupational therapy.
For purposes of benefit eligibility, under 1814 (a) (2) (C) and 1835 (a) (2) (A) of the Act, INTERMITTENT means skilled nursing care that is either provided or needed on fewer than 7 days each week or less than 8 hours of each day for periods of 21 days or less (with extensions in exceptional circumstances when the need for additional care is FINITE and PREDICTABLE). A patient must meet each of the criteria specified in this section. Patients who meet each of these criteria are eligible to have payment made on their behalf for services discussed in 40 and 50.
Part-time or intermittent skilled nursing care (other than solely venipuncture for the purposes of obtaining a blood sample);
Part-time or intermittent home health aide services;
Physical therapy;
Speech-language pathology;
Occupational therapy;
Medical social services;
Medical supplies (including catheters, catheter supplies, ostomy bags, supplies related to ostomy care, and a covered osteoporosis drug (as defined in 1861 (kk) of the Act), but excluding other drugs and biologicals);
Durable medical equipment while under the plan of care established by physician;
Medical services provided by an intern or resident-in-training under an approved teaching program of the hospital in the case of an HHA which is affiliated or under common control with a hospital; and
Services at hospitals, skilled nursing facilities, or rehabilitation centers when they involve equipment too cumbersome to bring to the home.
The term PART-TIME or INTERMITTENT; for purposes of coverage under 1861 (m) of the Act means skilled nursing and home health aide services furnished any number of days per week as long as they are furnished (combined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-by-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours per week). See 50.7.
For any home health services to be covered by Medicare, the patient must meet the qualifying criteria as specified in 30, including having a need for skilled nursing care on an intermittent basis, physical therapy, speech-language pathology services, or a continuing need for occupational therapy as defined in this section.
These companies are extremely nasty and restrictive with the provision of Physical and Occupational Therapy services particularly to bed bound patients or stroke patients with functional impairments to the extremities/limbs. The administration of these companies are notorious for pruning and molding what data gets inputted and reported to Medicare via the Oasis Assessment System and also dictate to the therapists their protocol boundaries and restrictions as to what services to award, when they can award them and the frequency of skilled therapy visits to award. Medicare mandates that any decision for patient care is supposed to consider the unique medical condition, and consider the overall condition of the patient, skilled therapy is to be provided that are reasonable and necessary to the treatment of the patient's illness or injury or to the restoration or maintenance of function affected by the patient's illness or injury (HIM-11 40.2.1). Here below are some memorable portions of the Medicare regulation that clearly establish that the Physicians and Skilled Therapist have the power to decide the merits of therapy for any patients via their professional judgment and diligent / detailed documentation and are the chief determinants of what therapy is provided NOT THE HOME HEALTH AGENCY ADMINISTRATION: Furthermore many corrupt money making physical and occupational therapists that collude with these type of despicable Home Health Agencies like to make blanket assertions as to what they claim their SOLE PURPOSE is as therapists. Many times you'll hear a Physical or OccupationalTherapist say our job is to get the patient to walk or increase their strength/ability to that end, the patient has to be verbally and physically able to follow the therapists commands and respond, the patient must be able to eventually perform the daily tasks such as any non disabled person would do (walk, eat, bathe, dress, groom, write, ambulate, achieve independence) fortunately that is not what Medicare regulation indicates. Furthermore, Medicare DOES NOT mandate that family members or anyone around the disabled individual must provide therapeutic exercises or range of motion if they are UNWILLING or feel incapable or unskilled to do so. Please note the following pieces of Medicare regulation particularly note that if the patients medical conditinos are numerous and complex the continual presence of a licensed physical, occupational, or speech therapist can be justified by appropriate documentation. Many would feel uncomfortable applying range of motion or therapy exercises to a patient that suffers from bone condition like osteoporosis or excessive spasticity or contracted tendons, who are at rish of fractures, who have delayed neuromuscular acivity, whose response to pain is compromised, who may aspirate into their lungs causing a life threatening pneumonia, and countless other reasons are justified according to Medicare regulation for an ongoing safe and effective maintenance program. The key as is repeatedly stated is proper justification for services rendered by the medical professionals involved. Acute, Chronic and conditions requiring long term therapeutic interventions are NOT EXCLUDED:
60 Covered Physical Therapy Services
160.5 Assessment
Medicare Benefit Policy Manual (CMS Pub. 100-2, Ch. 7 40.2.2A)
Visits by a physical therapist to assess rehabilitation needs and potential, or to develop and/or implement a physical therapy home program, are covered when reasonable and necessary because of the beneficiary's condition. Assessment should include objective tests and measurements such as, but not limited to, range of motion, strength, balance, coordination, endurance, or functional ability.
160.10 Therapeutic Exercises Medicare Benefit Policy Manual (CMS Pub. 100-2, Ch. 7 40.2.2B) Visits are covered for therapeutic exercises which, due either to the type of exercise or the condition of the beneficiary, must be performed by or under the supervision of a physical therapist to ensure the safety and effectiveness of the treatment. Documentation should identify a loss of function and the reason a therapist is necessary (type of exercise or beneficiary condition).
160.25 Maintenance Therapy
Medicare Benefit Policy Manual (CMS Pub. 100-2, Ch. 7 40.2.2E)
Repetitive services required to maintain function and prevent regression do not usually require the skills of a physical therapist. However, if the complexity of the procedures or beneficiary complications require the judgment and skill of a physical therapist to safely and effectively carry out the services, then the services MAY BE COVERED ON AN EXCEPTION BASIS. The documentation must clearly show the potential danger to the beneficiary and the reason (s) the skills of a therapist are needed.
A maintenance program may be established if, after an initial evaluation, the restorative potential of the beneficiary is judged to be insignificant.in such situations, the initial evaluation, the instruction of the beneficiary or caregivers, and re-evaluations until the program can be safely and effectively carried out, are all considered to be covered physical therapy services.
180.10 Documentation of Covered Occupational Therapy Services
A beneficiary's recovery and safety can be affected by perceptual and cognitive deficits. Documentation should identify how these deficits impact the activities of daily living, mobility, and/or safety of the beneficiary. Examples of documentation to show measurable improvement could include one or more of the following areas:
Example: Documentation reveals that the beneficiary responds by inconsistently performing functional tasks from day-to-day or within a treatment session.increased consistency within the same level of assistance may reflect improvement.
150 General Principles for Reasonable and Necessary Physical, Speech, and
Occupational Therapy
150.5 Principle One: Treatment Must Meet Criteria
Medicare Benefit Policy Manual (CMS Pub. 100-2, Ch. 7 40.2.1)
Therapy is considered skilled when the following criteria are met:
The inherent complexity of the service is such that it requires the skills of a therapist (or
Under the supervision of a therapist) to perform it safely and/or effectively.
The treatment is reasonable and effective for the illness, injury, or restoration/maintenance of function.
The recovery and/or safety can only be assured when total care, skilled or not, is managed by the skilled therapist.
Corinthians also has the tendency of pocketing the moneys meant for the provision of medical supplies to the patient. According to the Medicare Benefits Policy Manual Chapter 7 and Chapter 15, Home Health Agencies are paid under the Home Health Prospective Payment System (PPS) and this payment is a national 60-day episode rate with applicable adjustments. Many of these Home Health Agencies are extremely mediocre and restrictive when it comes to providing necessary supplies for the care of the patients that are accepted by them. Corinthians has a habit of not even providing gloves or dressings, duoderm, tegaderm or tape or sterilization products, saline, perineal wash all of which are considered routine medical supplies whose payment is factored into the 60 day Episodic Rate the Home Health Agencies are paid by Medicare. These companies have a habit of indicating Medicare does not pay for supplies and if there be a special supply for the appropriate medical care of a patient they elect to tell you Medicare DOES NOT pay for NON-ROUTINE SUPPLIES and instead choose to POCKET THE MONEY MEANT FOR SUPPLIES IN ITS ENTIRETY. Medicare regulation (Benefits Policy Manual Chapter 15) indicate any supply that can be directly identifiable to an individual beneficiary whose cost can be documented and accumulated in a separate cost center for later reimbursement by Medicare will be reimbursed to the Home Health Agency. Furthermore any supply documented in the plan of care, ordered by the Physician for the patient that have a therapeutic or diagnostic use is to be provided by the Home Health Agency to the beneficiary/patient and they must thereafter follow the proper billing protocol to obtain supplemental reimbursement for them (CMS Pub. 100-2, Ch. 7 80 and Ch. 7 50.4).
10.1 - National 60-Day Episode Rate
(Rev. 1,10-01-03)
Hh-201.1
A. Services Included
The law requires the 60-day episode to include all covered home health services, including medical supplies, paid on a reasonable cost basis. That means the 60-day episode rate includes costs for the six home health disciplines and the costs for routine and nonroutine medical supplies. The six home health disciplines included in the 60-day episode rate are:
1. Skilled nursing services
2. Home health aide services;
3. Physical therapy;
4. Speech-language pathology services;
5. Occupational therapy services; and
6. Medical social services.
The 60-day episode rate also includes amounts for:
1. Nonroutine medical supplies and therapies that could have been unbundled to part B prior to PPS. See 10.12. C for those services;
2. Ongoing reporting costs associated with the outcome and assessment information set (OASIS); and
3. A one time first year of PPS cost adjustment reflecting implementation costs associated with the revised OASIS assessment schedules needed to classify patients into appropriate case-mix categories.
B. Excluded Services
230 Medical Supplies
Medicare Benefit Policy Manual (CMS Pub. 100-2, Ch. 7 80 and Ch. 7 50.4)
230.5 Medical Necessity Criteria for Medical Supplies
Medical supplies must meet certain criteria to qualify for Medicare coverage. All medical supply items must:
Have a therapeutic or diagnostic use
Be ordered by a physician as part of a prescribed treatment
Under the HHA PPS consolidated billing requirement established by sections 4603 (c) (2) (B) and (c) (2) (C) of the Balanced Budget Act, the HHA that establishes the home health plan of care is responsible for the billing for all of the Medicare covered home health services including medical supplies. The medical supplies may be provided directly or under arrangement with an outside provider. HHAs are expected to separately identify in their records the cost of medical and surgical supplies not routinely furnished during visits and which are directly identifiable to an individual beneficiary. (Please refer to the CMS Web site (www.cms. Hhs. Gov) for a listing of the medical supplies consolidated under HH PPS.)
230.10 Nonroutine Supplies
The physician must order all nonroutine supplies.
Nonroutine supplies are identified by the following conditions:
The item follows a consistent charging practice for Medicare and non-Medicare beneficiary's receiving the item.
The item is directly identifiable to an individual beneficiary. The item's cost can be identified and accumulated in a separate cost center. The item is furnished at the direction of the physician.
In conclusion, I wish to stress to any of you out there who find this posting and care about the quality of care your loved ones receive that may require Home Health, DO NOT COMPROMISE STAND UP FOR THE BENEFICIARIES RIGHTS! DO NOT allow the continual extortion of Medicare especially when sick, elderly and disabled people are being short changed in their medically required services. Medicare's intent was to save money through the Home Health Benefit versus Hospitalizations cost but unfortunately these greedy money making Home Health Companies (many of which are predominated by Filipinos) not only extort Medicare but ensure medical complications and increased medical costs due of recurring Hospitalizations. Please remember there are many elderly, disabled and sick people out there who have no advocate, no caregiver, no one who can speak up on their behalf and who more often than not CANNOT DO IT FOR THEMSELVES. Please take it upon yourself to protect your loved ones educate yourself on the Health Insurance Regulations, Conditions Of Participation and Certification & Licensing requirements of your state. If we fail at this endevour then the rampant and overbearing abuse of the Medicare Home Health Benefit will never be improved and corrected! Please report inconsistencies, corruption and Fraud to the State Surveyor and Certification or Quality and Compliance regulatory body, to the Regional Office of the Centers for Medicare and Medicaid Services, to the Regional Home Health Intermediary, to the Quality Improvement Organization (in Nevada it is Health Insights) to the Office of the Inspector General. It is also smart to post your reviews of BAD Home Health Companies online on any websites that sponsors communication such as insiderpages.com, homehealth patient review websites, merchantcircle.com (use Google to locate them) and copy them to the Better Business Bureau both local and online and to the Consumer Affairs where possible. I encourage contact if anyone wants further information as I have researched these matters very extensively
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