Medicare Benefits

Medicare, as well as some other insurers, has certain requirements for home health benefits. They include the patient being eligible for Medicare benefits, being homebound, being under the care of a physician who establishes and reviews a plan of care, the skilled care occuring on an intermittent basis, and the services being medically necessary and reasonable. ConfiCare® can help you fully understand these requirements by clicking on the links provided or by contacting us.

 

Homebound Status

In order for a patient to receive home health under the Medicare benefit, the patient must be homebound. By definition, homebound status is met when the patient has considerable or taxing effort when leaving the home. Homebound status does not mean the patient is confined to the house, just that he or she is normally unable to leave the home unassisted. In addition, this status must continually be detailed in supporting documentation throughout the care of the patient.

Intermittent Care

Medicare requires skilled services to be provided on an intermittent basis. These skilled services may be provided by a nurse, physical therapist, speech therapist, or a combination of those listed. Usually, this care has a finite end point defined in the patient’s plan of care.

Under Physician Care

Medicare requires the patient to be under the care of a physician who works with the home health provider, patient and family to establish a plan of care. In addition, the physician is required to periodically review the plan of care.

Reasonable/Necessary Services

The services provided should be reasonable and necessary. Medicare may request supporting documentation for services provided to ensure this requirement.