On the Healthcare Front
Issue #16: June 2023
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when should you call kepro?
- If you are not ready to be discharged from the hospital.
- If your Medicare skilled services are ending too soon. Examples of skilled services include things like physical therapy and nursing services.
- If you have a concern about the quality of care you received.
- If you have a concern about your medical care that needs to be taken care of right away.
Click on the link below for the phone number for your state. These services are free for people who have Medicare.
june is men's health month
Men’s Health Month is used to raise awareness about health care for men and focus on encouraging boys, men, and their families to focus on healthy living.
Read more about Men's Health Month:
be on the lookout for medicare fraud
Senior Medicare Patrols are organizations that can help you and your family, and caregivers to prevent, detect, and report healthcare fraud, errors, and abuse.
Some common examples of possible Medicare fraud or abuse are:
- Billing for services or supplies that were not provided.
- Providing supplies to patients that they didn't ask for.
- Misrepresenting a diagnosis, a patient's identity, the service provided, or other facts to justify payment.
Learn more by listening to Kepro’s podcast – Aging Health Matters. Episode 11: Fighting Fraud With The Senior Medicare Patrol is a conversation with Senior Medicare Patrol staff who talks about how they help fight Medicare fraud and what you can do to protect yourself.
You can also visit the Senior Medicare Patrol website for more information.
The Public Health Emergency for COVID-19 ended on May 11, 2023.
After May 11, 2023:
- Medicare will continue to cover COVID vaccines.
- You might have to pay out of pocket for COVID-19 diagnostic tests.
- Medicare won’t cover over-the-counter tests.
- Telehealth services will continue through December 31, 2024.
If you don't know what telehealth means, visit www.telehealth.hhs.gov.
Visit medicare.gov to learn more about these changes.
For details about the end of the public health emergency, read the news release from the U.S. Department of Health and Human Services: Fact Sheet: End of the COVID-19 Public Health Emergency
To read more about COVID-19, including symptoms, visit the Center for Disease Control and Prevention COVID-19 web page.
getting help when you don't understand what is happening during a discharge from a skilled nursing facility
Immediate Advocacy is a free service for people with Medicare. It is used to help people quickly resolve a problem about medical care or services. Immediate Advocacy often involves Kepro calling a healthcare provider or facility on behalf of the patient.
This story is about a patient who went from the hospital to a skilled nursing facility and is now being discharged (the patient is going home).
You may wonder – What is the difference between a skilled nursing facility and a nursing home?
The answer – It’s the care that is provided.
Skilled nursing care is done by registered nurses in a medical setting under a doctor’s supervision. It’s basically the same level of nursing care you get in the hospital. Patients may go from the hospital to a skilled nursing facility to continue recovering after an illness, injury, or surgery before going home.
Nursing home care is provided mostly by licensed practical nurses and nurse aides under the supervision of a registered nurse. Care is focused on activities of daily living, like dressing, bathing, and eating.
Alfred (or Al, as he was called by his family and friends) had been in the hospital to have surgery on his knee. He had a routine surgery and spent a short time in the hospital. His doctor was concerned about how he was healing – he had a severe open wound – and discharged him to a skilled nursing facility. Al and his wife, Wendy, were happy about his progress.
Soon, Al was being discharged to go home. He was excited to be going home. His wife, however, was worried and had concerns about his discharge plan. As she was looking through the paperwork from the hospital, she found Kepro’s phone number and decided to call.
Al’s wife was soon connected to a nurse in Kepro’s Immediate Advocacy department. The nurse listened to her concerns about her husband’s discharge plan from the skilled nursing facility. She felt she would not be able to care for him at home and was concerned they would “discharge him to the street.” The Kepro nurse told her that would not happen and said that she would call the facility to find out the plan.
Kepro spoke with a social worker at the skilled nursing facility. The social worker said that the plan was for the patient to be discharged to home with home health services. A nurse would be visiting Al at home to continue his wound care. The social worker said that the patient’s wife had been told of the plan several times, but she possibly had some dementia issues.
The Kepro nurse called Al’s wife to let her know of the plan and also called the social worker and asked him to follow up with the patient’s wife and give her a paper copy of the detailed discharge plan.
Read more about Immediate Advocacy on Kepro's web site: Immediate Advocacy
Discharge Planning Checklist (PDF), a publication from Medicare
Print out a card for your wallet: Wallet Card (PDF)
Publication No. RI146810-299-5/2023. This material was prepared by Kepro, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.