Home care programs have largely reduced readmission rates and improved adherence for elderly and disabled patients. However, the programs have come under recent scrutiny by federal health officials who have questioned whether home visits are being used as opportunities to upcode reimbursement from Medicare, reports Tampa Bay Times.
Humana's in-home care management program, Humana at Home, serves nearly 1 million nationwide and is growing by about 1,500 members daily, Humana's director of telephonic care management Kate Marcus told Tampa Bay Times.
Humana's program nurses assess members' general health, activity level and risk of falling, ensure medical adherence and even help arrange transportation for patients. An internal analysis found Humana at Home reduced hospital readmissions by 45 percent, according to the article.
But for all its merits, federal officials have warned home health programs may encourage coding abuse by insurance companies in order to collect more Medicare dollars.
In 2014, the Center for Public Integrity found the rising number of home visits has correlated to a rise in risk scores insurers submitted to CMS for payment, putting upward pressure of Medicare costs.
CMS has since warned in-home assessments were "merely a strategy by [Medicare Advantage] plans to find and report more diagnostic codes to CMS, generating higher levels of coding and, therefore, payment than assumed under our risk adjustment methodologies," according to Tampa Bay Times.
Home care programs have recently ballooned under many other insurance plans, including OptumCare and WellCare.
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