With all of the changes that are taking place in healthcare we need to realize that Medicaid and Medicare are changing too.
What we know at this time is that Medicaid is continuing to remain in place for patients from age 0- 20, and will pay for rehabilitation during that time period, when prescribed by their treating medical professionals. The only other coverage for therapies for adults is in the outpatient hospital setting and then payment is made to the hospital and is subject to the Medicaid recipient's outpatient cap (limit).
The purpose of the therapy services program is to provide medically necessary physical therapy (PT), occupational therapy (OT), respiratory therapy (RT) and speech-language pathology (SLP) services to recipients from birth through age 20.
The therapy services program also provides services to recipients age 21 and older for SLP services pertaining to the provision of augmentative and alternative communication systems and PT and OT services pertaining to wheelchair evaluations and fittings.These are the only services in the therapy program that Medicaid reimburses for adults.
As far as Medicaid payment when secondary to Medicare, there is a very slim chance that Medicaid would ever make payment to a provider in that it would only be when the deductible is due if at all, since the Medicare payment is generally 80% of the Medicare allowed amount.
Once a patient's deductible has been met, the Medicaid fee is calculated at 50% of the Medicare fee in that situation.
Medicaid's policy regarding services that are covered by Medicare and not covered by Medicaid is as follows:
Cost Sharing overage for Medicare Part B Non-Covered Services:
Effective retroactive to October 1, 2010, there is a change in the Medicare Part B deductible and coinsurance for services not covered by Medicaid. The Medicaid rate for these services is established as 50 percent of the Medicare allowed amount. If Medicare pays more than the Medicaid rate, the Medicaid payment is zero. This coverage is available for Medicare recipients who are eligible for either:
Please notify us through "Contact Us" with any questions. I am sure the Medicaid role and coverage will change as the healthcare changes take place. "Now, let's get going!" xo Sally
To learn more about the Occupational Therapy Services Sally Thimm OTR/L offers visit: Professional Case Management of SWFL
We have so much power. You may not believe that you have any power, when it comes to dealing with tough situations. But you have all the power.
Whether you are a Caregiver or the person challenged with a tough medical situation, how you approach each day, will either strengthen you or weaken you. Don't let it weaken you.
Learn from each day. Get up in the morning with the faith that you will be the light today. Put a smile on your face. Look up, not down.
If the people around you refuse to be positive, that's ok. Your light and positive attitude will make it difficult for them to stay negative. Start where you are. You are amazing, and you need to believe that! xo Sally
To Learn more about Sally Thimm OTR/L and her Occupational Therapy Services visit Professional Case Management of SWFL
Well, here we have a topic that belongs to everyone. My intention is to put information here that is interesting to patients and caregivers that will motivate them to move their daily habits to more healthy choices.
So bring your thoughts and comments. What you do to bring yourself some inner peace each day may help another. Let’s face it….we need to refuel our “energy tanks” each day.
Stress is a killer. It makes you emotionally challenged and can make you physically ill. Some people need to take medication to manage their levels of depression and anxiety. What I am hoping for here is a way to share good energy and realize that we are not alone in our frustration and feelings of guilt, when we are tired of the job that we do each day as caregivers. It doesn’t mean we don’t love our friend or family member, it just means that we get tired. That is normal. What we do about it…that is the important thing.
Exercise? How about let’s move more! What are some exercises you can do during the day, without leaving the house? Housework is an exercise, but not much fun though. How about putting on some music and dance around the house while you clean up the kitchen? Or dust the living room. Make it fun! Try it. Let us know what happens. Music can be magic…to transform how you feePut on some head phones! Listen to music, or motivational messages. There’s lots of positive stuff out there! Let us know how you handle stress! Send us your thoughts! Let us know what you need! Go to “Contact Us” and share your story! “Let’s get going!” xo Sally
To learn more about the Occupational Services Sally Thimm OTR/L offers visit: Professional Case Management of SWFL
If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL
Why do we choose to stay in the same city, the same job, or keep the same routine?
It’s safe. It’s predictable. It is scary to move out of your comfort zone. But why not try something new in small doses?
Decide today that you want to be more. Be more of who you were destined to be. Don’t be that person that wishes they had learned a new skill or traveled to a certain city or country…and never do it.
We have one life, and it’s important to spend it learning, helping others, growing and becoming….all you were intended to be.
The problem is, the growth won’t happen, the experiences won’t be had, and you will never have the chance to experience more if you don’t start in some small way, today. Give it some thought over the weekend. Plan one or two things to do next week that you have wanted to do, but never took the time to do them. Let us know what you learn! “Now, let’s get going!” xo Sally
"Allergies" is a huge topic and there are as many different allergies as there are diseases. How each allergy affects one person, may affect another person differently. This section will discuss various allergies that are common concerns for people, especially when they are dealing with other medical conditions. The most important thing to remember is that you should have your individual allergies well documented on your current medication list, and make sure that all of your treating medical professionals are aware of them.
In this section of Sallycares.com we focus on the changes that are happening with insurance coverage and provide you with information about those changes as we are made aware of them.
Whether it is Medicare, Medicaid or Commercial insurance, we are all noticing changes that are affecting our policies and coverage.
For Sallycares.com members we are more than happy to follow up on any specific insurance question that you may have regarding your insurance changes, but we are not able to suggest another insurance company and guarantee that you would not potentially have another issue. Your insurance agent should have the best information for you, since they would have knowledge of your health history and any specific needs you might have.
Commercial Insurance: There are many types of commercial insurance policies. They vary associated with the amount of deductible that is charged, as well as the type of coverage they provide. Usually, the higher the deductible, the lower the monthly premium. With the initiation of “Obama Care” there are anticipated changes that will be coming, but we are not exactly sure how the changes will roll out. Stay tuned as we learn more.
Medicare and Medicaid: Both of these programs are changing and the rules associated with how coverage will be altered are not yet clear. The newest update that we have received has been associated with Medicare’s changes regarding the provision of Durable Medical Equipment or DME. There is additional information regarding that change on the web site. The most important thing to know is that all prescribed equipment will now be provided by a supplier that won a “bid” for a specific zip code or geographical area. Example: If you are in Florida for the winter and need a wheelchair, the providers that are treating you in Florida are responsible to determine your zip code from your actual county of residence up north. Your state of residence zip code is where your equipment will need to be provided from. So that means that your wheelchair will need to be shipped from whichever supplier that is the area Medicare provider up north, to Florida. I know that the process sounds more complicated than what you are used to, and it is.
These are uncertain times regarding our healthcare. We all need to be our best advocate, and learn how to do that. Join Sallycares.com today and have support while we unravel all of these insurance issues together. As a member you can always send us your questions through “Contact Us,” and we will be glad to review your concerns!
“Now, let’s get going!” J Sally
Sallycares.com is providing general information related to a number of medical conditions, and more will be added as we grow. The purpose here is not to place general information in these areas that you can find all over the internet. I will be placing new information and links to resources for the various areas, but our focus is on managing the symptoms that you are living with every day. Medical Conditions that are discussed are: Breathing Problems, Diabetes, Health and Wellness issues, Neurological Problems and Weight Management.
For example; when memory becomes a challenge we will look at the specific problems that reduced memory is demonstrating in the home, and give you ideas associated with how to manage them. Problems with managing your bathing or dressing due to physical limitations you have begun to experience will be discussed, and options for managing the problems will be suggested.
One thing you have to be aware of is how important it is to stay on top of whatever disease process you are dealing with. You want to do your research. You want to know if you are doing all you can do related to reducing the symptoms you are experiencing. Many times exercise and just increasing your general activity is helpful, even when pain is one of the symptoms you are trying to reduce.
Engaging in an activity that has meaning or enjoyment for you is very helpful. When you can get up every morning and do your daily activities, not be exhausted from them (because you are using energy conservation techniques), and you have the energy to do something that takes you outside of yourself and focus on something or someone else, it is very healing.
Negative emotions and negative energy are things that we need to discourage within us. They are not helpful. We can’t become more positive and reduce stress if we focus on the negative.
Disease causes people to have to change their lives. Living with pain, limited strength, problems with balance and difficulty walking are just a few of the problems people deal with every day.
What if we didn’t focus on them? What if we just accepted that they exist and we need to focus our energy on something positive? What would it be?
I often tell people that they begin to heal (sometimes emotionally – but not physically), when they 1. Understand what is wrong with them 2. Learn how to manage the condition.
In medicine we cure very few things. We treat diseases. Join Sallycares.com to learn more.
As a member you can always send us your questions through “Contact Us,” and we will be glad to review your concerns!
“Now, let’s get going!”
This section is currently under development. We are going to be discussing current topics associated with Clinical Research, and listing current research trials that are of specific interest to you and your family.
Take the time to register your Name and Email Address so you can stay current with clinical trials that are associated with treating:
Stay tuned for more information!
"Now, let's get going!" xo Sally
Stress. We all have it, and the amount of it varies, depending on what is happening in our lives.
When you are a Caregiver and you are trying to manage a difficult situation, you have limitations. You cannot be it all and do it all, because you do not have that kind of control. And that is a good thing.
Why? Because Caregivers have to learn to depend on others to help reduce some of their stress. When you are dealing with medical issues, home management issues and financial responsibilities, some things will work, some things won’t, and it is all a learning process.
What you need to remember is that you are not alone. You need to stop each day and take a deep breath and remember that life comes full circle, and what we are given to deal with in our lives does not come to stay. It comes to pass.
We learn through it and because of those experiences we become more understanding. We may need to work through a lifetime of memories that might have not been so great, to come to a time that allows us to understand that we are all human. Our parents have made mistakes. We make mistakes. We need to forgive.
When you allow yourself the luxury of forgiveness, it becomes easier. Enjoy today.
“Now, let’s get going!” xo Sally
If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL
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