If you need health care services that aren't covered by Original Medicare, you might consider enrolling in a Medicare Advantage (Part C), Medigap, or PACE plan. Medicare won't pay for 24-hour Home Care near Los Angeles CA or for meals delivered to you at home. Nor does it cover help for what are called “activities of daily living”, such as bathing, dressing, going to the bathroom, eating, or moving from one place to another in the home. 9.Medicare Part A (also known as hospital insurance) can generally cover inpatient hospital care, nursing facility care, nursing home care, palliative care, and Home Care near Los Angeles CA. While not required, the ABN provides an opportunity to let the patient know that Medicare does not cover the service and that the patient will be responsible for paying for it. If you qualify, Medicaid, which is administered by states according to federal guidelines, can cover care in nursing homes.
Medicare Part B (health insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Nor does it cover help for what are called “activities of daily living”, such as bathing, dressing, going to the bathroom, eating, or moving from one place to another in the house. When Medicare or another payer designates a service as “combined”, it does not pay separately for parts of the combined service and does not allow the patient to bill for it, since the payer believes that the payment is already included in the payment for another service that it does cover. Examples include preoperative and postoperative care when a surgery is billed or billing for multiple laboratory procedures when a single panel test represents the service performed. For example, Medicare doesn't cover breast augmentation for cosmetic reasons, but it does cover reconstructive surgery after a mastectomy.
The “exclusive” option eliminates duplicate payment for these items, since you only pay once to provide the service. For example, the patient wants to receive the service more often than Medicare allows or to receive a diagnosis that Medicare does not cover. In all cases, if the patient's policy coverage isn't clear, tell the patient that they may be responsible for paying for the service. For example, in the case of a medical consultation needed at the same time as a preventive medicine consultation, you can bill for the uncovered preventive visit (excluded), but you must subtract the charge for the covered service from the charge for the service not covered.
