Positioning Your Private Duty Agency to Align

Positioning Your Private Duty Agency to Align with Medicare Advantage Providers

The Centers for Medicare and Medicaid Services, CMS, will allow Medicare Advantage plan to offer benefits for private duty home care, including non-skilled in-home support for daily maintenance and activities.
The premise behind this change is that assistance with daily maintenance activities, such as bathing, dressing, and other tasks, can reduce the potential for injury and therefore reduce the utilization of emergency room visits and hospitalizations.
Private Duty agencies will need to demonstrate to Medicare Advantage providers their home care program is a program which aims to deliver high quality care with the same objective; keeping clients safe and in their home environment. Agencies will also need to demonstrate their commitment to sound billing practices as well as the prevention of fraud and abuse.
ACHC Accreditation Standards necessitate the development of a Performance Improvement Plan which can target issues that result in emergency room visits or hospitalizations and implement practices and protocols to reduce precipitating events. The development of a Compliance Program validates an agency’s resilience to fiscal responsibility.

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