Many years ago, the Alzheimer’s Community fought diligently to secure the Medicare Home Health Physical Therapy Benefit (http://www.ec-online.net/Knowledge/Articles/medicaredementia.html). Although this service was technically covered by Medicare, providers encountered a high percentage of payment denials. Thus, Home Health Agencies stopped accepting these referrals for a long time until the advocates stepped up and Medicare reversed the denial trend.

As we know the old saying, ‘History Repeats Itself’. I have witnessed a similar trend in recent years and fewer Alzheimer’s patients are receiving the in-home therapies needed. This time, Home Health Agencies are faced with ADR (Additional Documentation Requests) by Medicare to substantiate and justify the services to Alzheimer’s patients. It is very difficult to demonstrate any potential progress for an Alzheimer’s patient, so Medicare has a foundation for taking back payments. From the Agency standpoint, too many ADRs can result in a RAC Audit and that’s really, really not good. So, again, Alzheimer’s patients are inadvertently targeted and may not receive the in-home care necessary.

For patients and families, go on Medicare.gov and identify the top performing Home Care Agencies. These agencies are less likely to be impacted by the ADR & RAC Audits so they may be more capable to service an Alzheimer’s patient with their therapy needs.