What do you do when a Home Health Agency stops their service because Medicare will not pay because the agency has their coding incorrect?


The Home healthcare agency informed me on Friday @ 4:00pm that they will suspend the services that they give to my mother (84 yrs. old) because her insurance company have not paid them since December. I contacted the insurance company and they stated that the coding on the claim is incorrect and told them to resubmit the claim with correct coding. They have offered to help the company code the claims. The Home Health Agency stated that it will take 45 days for them to pay them and they will need to cut their losses.

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One problem with Medicare and home health is that Medicare pays for Medical needs for home health, but generally not for "custodial" care, like bathing and general care. If the agency coded it wrong, you should keep on them to correct that. That is their job. They won't keep a reputation long if they don't get their system right. If your mom had custodial care, then it's not a coding problem, it's just not covered by Medicare. However, if the care was medical in nature, keep on them. Good luck,
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Pearlwait1, I have had 3 yes 3 Home Health Care agencies from reputable hospitals provide services for my mom both in home and in assisted living. Each one of them gets paid, yet it does take calling and asking why it is still "In Progress" or is there something else they need. It is very sad to know that as soon as the patient is no longer showing adequate progress- they release her.
Now I am having to pay out of pocket for a "Personal Care Assistant"- who is a nurse to go into the AL and bathe her. The nurse also help with ambulation. It is truly sad that a one point they just don't get better. Good luck and enjoy the time you have now.
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