OTHER PROVIDER TYPES

In addition to the providers discussed in detail in this section, the Centers for Medicare and Medicaid Services (CMS) also recognizes these provider types: home health, hospice, skilled nursing facilities (SNF), critical access hospitals, durable medical equipment (DME), rural health clinics, pharmacists, ambulance, anesthesiologists, and clinical labs. We'll define each of these briefly so that you're aware of their purpose and function.

• Home Health is healthcare that is provided in one's home. Home health care is sometimes used interchangeably with the term homecare, but homecare can refer to all medical and non-medical care that is provided in the home, while home health care refers specifically to medical care. Home health care can be provided by a variety of licensed healthcare professionals, but registered nurses (RN's) and licensed practical nurses (LPN's) are common. The requirements of home health providers can vary by state.
• Hospice is a type of healthcare that deals with providing comfort and support to patients who are terminally ill. In other words, when a patient's illness has reached a point where it will no longer respond to cure-oriented treatments, hospice attempts to relieve the pain and suffering of patients in their final days and attends to their emotional and spiritual needs.
• Skilled Nursing Facilities (SNF), also known as nursing homes, are medical care centers where individuals reside when they require continual nursing care and can no longer live on their own. In the United States, a skilled nursing facility specifically refers to a nursing home that has been certified to participate in and be reimbursed by Medicare and Medicaid.
• Critical Access Hospitals (CAH) are hospitals that are located in rural areas where healthcare options are limited and their services are vital to the community. To become a CAH, a hospital must meet certain requirements and be certified by Medicare. CAH certification allows critical access hospitals to receive enhanced, cost-based reimbursement from Medicare and Medicaid to reduce hospital closures in underserved areas.
• Durable Medical Equipment (DME) refers to any medical equipment that is used in the home, primarily used to treat a medical condition, would not be used in the absence of an illness or injury, and can withstand repeated use. Common DME examples may include wheelchairs, CPAP's (for sleep apnea), and iron lungs.
• Rural Health Clinics are a Medicare designation for medical clinics that offer primarily primary care services and are located in rural, medically underserved communities. To qualify, a clinic must be in a non-urbanized area and must employ a nurse practitioner or physician's assistant among other requirements. Once designated at a rural health clinic, the clinic is allowed to receive enhanced, cost-based reimbursement from Medicare and Medicaid.
• Pharmacists are healthcare professionals who are properly licensed to prepare and dispense medications. Pharmacists undergo extensive training and often interpret and communicate important drug information to patients.
• An Ambulance is a vehicle specially equipped for transporting sick or injured individuals and for offering medical care during transportation if necessary. Ambulances often transport individuals to and from hospitals and other medical care facilities.
• Anesthesiologists are physicians who are trained and licensed in anesthesia and perioperative medicine. In layman's terms, and in general, anesthesiologists administer the drugs that allow a patient to undergo surgery without pain and are also trained to monitor the patient throughout the surgical process.
• Clinical Labs are tests that are performed on clinical specimens obtained from patients in order to gain information pertaining to the diagnosis, treatment, or prevention of disease. Common clinical lab tests include cholesterol tests, sexually transmitted disease (STD) tests, and pregnancy tests among many others.

You may notice that we do not discuss Dentists here. This is because Medicare does not cover dental benefits and thus does not recognize dental providers.

Essential QSA Knowledge

Knowing the purpose and function of healthcare providers can help tremendously in informed healthcare decision-making. Although we haven't devoted as much time to these providers as some others, hopefully this is enough to give you a general understanding of their role in healthcare delivery.

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