Which Home Health Services Does Medicare Cover?
Medicare covers such as:
- Part time or intermittent skilled nursing care
- Home health aide services (with skilled care need)
- Physical therapy
- Occupational therapy
- Speech therapy
- Medical social services
- Certain medical supplies
- Certain medications
- Durable medical equipment (80% of approved amount)
Which Home Health Services are Not Covered by Medicare?
Medicare are not covered such as:
- 24 hour-a-day care at home
- Meals delivered to the home
- Homemaker services, such as shopping and/or cleaning
FREQUENTLY ASKED QUESTIONS
Important Things you need to know such as:
What are the criteria for admission in Home Health?
There is a reasonable expectation that the patient's special needs can be met by the services provided to the patient by the Agency. The agency will not accept patients whose care needs are determined to be beyond the scope of care or staff that can be provided by the agency.
Environmental conditions must be conducive to adequate treatment of the patient and the safety of staff and patient. - The patient must be able to care for him/herself in between visits from Agency personnel if there is no reliable paid or voluntary primary caregiver available to meet all of the needs of the patient between visits by the agency.
The patient will reside in the licensed geographical location serviced by the agency.
Medicare patients will meet the criteria of the Medicare Conditions of Participation, as applicable.
The patient or patient's legally authorized representative must consent to care.
As appropriate to services provided, orders are obtained and signed from a licensed doctor of medicine, osteopathy or podiatry.
What are the requirements to be eligible?
- In order for a patient to receive home health care, several criteria must be met. Under Medicare guidelines, a patient must be homebound and require either skilled nursing care, speech therapy, physical therapy, and/or continuing occupational therapy on an intermittent basis in his or her home setting.
- "Homebound" is defined as a condition upon which a patient is essentially confined to a place of residence due to an illness or injury. He/she may be ambulatory or otherwise mobile, and are unable to be absent from his or her residence except on an infrequent basis or for periods of relatively short duration.
- Additionally, the patient must have an attending physician who is willing and able to assume full responsibility for the patient's medical care while receiving home health services.
What do you mean by Transfers and Discharge?
Transfer, referral, or discharge from this agency may result from several types of situations including the following:
- The level of care you need may change
- Situations may develop that affect your welfare
- There may be a failure to fulfill your responsibilities as a patient
- Moving out of our service area
You will be given timely advance notice of a transfer to another agency or discharge from our agency, except in case of an emergency. If you should be transferred or discharged to another organization, we will provide the necessary information pertinent to your continued care. When discharge occurs, you will receive instructions for ongoing care or treatment.
How about my Financial Responsibility?
- Payment for services can be through Medicare, Medicaid, Worker's Compensation, Veteran's Administration, state assistance programs, private insurance, or private pay.
- If you are covered by Medicare, there is no deductible and 100% coverage for most horns health services. A few items are covered under Medicare Part B and are only covered at 80% Supplemental co-insurance will cover the remaining 20% or you may be billed for the difference.
- Any charges for services will be discussed with you prior to the rendering of services. Prior to, or upon admission, the patient/client, guardian, caregiver, or family members will be informed verbally and in writing of all charges for services provided and methods of payment.
- Medicare beneficiaries receiving home health care from our agency may receive periodic statements from Medicare, which are NOT BILLS. These statements come from the Medicare insurance company that pays us for the care we give to you. They are intended to keep you informed and ask that you seek clarification of any items of which you are unsure. If you have any questions about these statements, please let us know.
What do you mean by Coordination of Care / Continuity of Care?
The Director of Operations is responsible for the overall coordination of patient care and services, including care provided through written agreement. The patient is responsible for informing the agency when unavailable for a visit. Visit schedules are coordinated whenever possible. Patients are notified of significant changes in schedule prior to scheduled visit time, unless an emergency situation prevents it. Patient care will not be interrupted due to staff absences. The DOO or designee will ensure appropriate staff assignments and coverage. In the event an ordered service cannot be performed, the physician shall be notified and new orders obtained as indicated, and patient will be referred to another provider accordingly.