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  • From: "Lynda" <lurine AT com-pair.net>
  • To: <homestead AT lists.ibiblio.org>
  • Subject: Re: [Homestead] The future of eldercare in the US
  • Date: Sat, 8 Aug 2009 13:08:37 -0800

Drew, the folks you are talked to are really out of date or just plain
telling tall tales. Ontario currently has a world class air ambulance
system.

(O.K., I knew you wouldn't take my word for it <g>, so I went digging on the net. Perhaps you'll believe the Toronto newspaper http://www.healthzone.ca/health/article/609875)

As to Medicare/Medicaid. I hate to break it to you but the same is true of
the insurance companies here in the U.S. AND you are more likely to run into
roadblocks from them than from the government run Medicare/Medicaid.

The newbee nurses, and worse, the burnt out nurses call the shots for
insurance companies, NOT Medicare/Medicaid.

As to Medicare/Medicaid DME situations. Doesn't even take a nurse to do
that, so I don't see the problem. *Someone* has to do the approvals.
Unfortunately, in this country at least, we have too many docs that are like
the boob that worked for MJ, anything for money!

BTW, helicopters or air ambulances or whatever the heck you want to call them are NOT the cure all in places like Ontario. They can't fly 24/7/52! About 40% of any given year has weather that doesn't let them off the ground. You need to bare that in mind also!

Lynda
The press corp is fact-adverse but very fable friendly.

----- Original Message ----- From: <DSanner106 AT aol.com>>

Nope, they have lived with this situation and you and I have not, so the
idea that we are better informed is rather silly. Idiots who don't want to
live with the pain for a year before treatment is rendered? I guess I
might
be an idiot too, If I could drive 60 miles, get immediate treatment and
end
the pain. The fact that Quebec since going to socialized medicine has not
had any trauma helicopter service, common in the entire US. because of
the
expense is inexcusable. What other technology will they not use to save
lives, in order to cut costs? Will they ground them here as well once we
switch > over? When actress Natasha Richardson died a few months ago
from a head
trauma, the doctors in Montreal and NY said she quite possibly would be
alive if the helicopter were available rather than the 4 hour ambulance
ride to
Montreal. I doubt her family is comforted with the knowledge that Quebec
saved a few bucks

The guidelines for treatment in Canada, as in the US for medicaid/medicare
are written
and approved by the government. In neither case can doctors do as they
feel
best and be
assured of payment if they have to step outside the guidelines. Sure, they
can order that
MRI, but they may not get reimbursed for it. It is not doctors, but
records
nurses who
generally determine what services you will get from our govt. or the
Canadian govt. My wife
has friends doing this today. Nurses from the govt. negotiate with nurses
from the providers.
Often they are nurses who go into this right out of college, without any
or
with very little practice
time. See the job posting today for description: note, no hospital
experience necessary, but lots of computer and communications skills are.

Drew

Medicare DME Reconsideration Nurse
Categories: Healthcare Specialists

The Medicare DME Reconsideration Nurse oversees medical necessity appeals
of Durable Medical Equipment (DME) under Medicare Part B.
Responsibilities
include: the organization and management of DME appeals; researching
Medicare determinations and policies, including but not limited to to
National
Coverage Determinations, Local Coverage Determinations, Jurisdiction
Supplier
Manuals, and Internet only manuals; reviewing appeals and completing
nurse
reviews regarding medical necessity, compliance with documentation
requirements, and utilization; and facilitating communication with our
client.

Requirements:

Active RN license
Two years experience processing Medicare DME reconsiderations
Bachelors degree or advanced certifications preferred
Strong written and verbal communication skills.
Ability to perform intensive research.
Highly organized with attention to detail and the ability to manage
multiple priorities and deadlines.
Strong proficiency in MS Outlook, MS Word, and Internet searches
Medium proficiency in MS Excel
Ability to read and interpret medical documentation written in Spanish
helpful




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