Question

Louise is an 89-year-old woman who was discharged from the hospital after having a cardiac valve replacement for mitral valve stenosis. After going home, she had home health services for a few weeks. Louise had both Medicare and a secondary insurance. She received a bill requesting payment for the home health services provided. She was prepared to write a check for the total amount. Fortunately, her granddaughter, Marie, a HIM professional, was visiting and reviewed the bill. Marie immediately saw that neither Medicare nor the secondary insurance had been billed. Marie assisted her grandmother by calling the home health agency to discuss the bill. She was told that the home health agency did not have the insurance policy numbers. Marie provided the policy numbers. When she was about to hang-up, the billing office representative told Marie that when Louise received a Medicare Summary Notice from Medicare to call them back to let them know so that they could bill the secondary insurance. Marie explained to them that it was their responsibility to identify this. If Marie had not gotten involved, then Louise would have paid the bill and her insurance companies would never have been billed. Also, Louise would have called the home health agency to ask them to bill the secondary insurer.

1. Identify how this case applies to the chapter.
2. What could the home health agency have done in order to prevent this problem.

  

Answer 1

This shows the poor management process of the home health agency in counter checking whether the patient has medicare coverage or not .Poorly trained staffs who requesting to make patient party to inform them in regards to secondary insurance.

Some of the things which could have been done in order to prevent this problem are

• The home health agency at the time of first visit or on the first day before offering the service should have gone through the insurance availability of the patients completely
• Before making the bill the agency should have checked with the patient by making a telephonic call about the amount to be paid .If done could have avoided the generation of bill.
• The staffs should be trained adequately
• A team to handle the insurance should be formed.