Page 8 - Home Health Marketing

Should any change be made in this policy regarding services or charges, you
or your responsible party will be advised. Please call our office if you have
questions about charges or insurance billing.

MEDICARE REQUIREMENTS FOR HOME HEALTH CARE

The following are required for Medicare to pay for your home health care services:

 You are homebound as certified by a physician. This means that, due to
your illness or injury, leaving home is either contraindicated or requires
the aid of assistive devices, special transportation or assistance from
another person. In addition, a normal inability to leave your home must
exist, and leaving your home takes a considerable and taxing effort. You
can still be considered homebound if your absences are infrequent or of
relatively short duration. You can leave home to attend a state licensed,
certified and/or accredited adult day-care program to receive therapeutic,
psychosocial or medical treatment; to receive medical treatments such as
outpatient dialysis, chemotherapy or radiation therapy; to attend a
religious service; or to attend unique or infrequent special events (family
reunion, funeral, graduation, etc.). If you are able to drive, then you
probably do not meet the homebound requirement.
 You have had a recent illness or injury (or worsening of a condition) which
requires Skilled Nursing Care on an intermittent basis (other than solely
venipunctures), or Physical Therapy, Speech-Language Pathology or have
a continuing need for Occupational Therapy.
 You are under the care of a physician or non-physician practitioner (as
applicable by state law) who has seen you for the condition for which home
health services are being ordered and provided by the agency. If the
services are not reasonable or medically necessary and specifically ordered
by your physician, Medicare will not pay for those services.
 You are in need of intermittent care. This means Medicare will not pay for
our health care staff to stay with you for an extended period of time. We
will only visit you for the length of time it takes to provide the specific
treatment ordered by your physician.

If all of these requirements are met, Medicare will also pay for medically
necessary Occupational Therapists, Medical Social Services, Home Health
Aides and medical supplies.
FACE-TO-FACE ENCOUNTER

If Medicare or Medicaid is paying for your home health services, one of the
following face-to-face encounter requirements must be met:
 You have been seen by a physician or non-physician practitioner within the
past 90 days or within 30 days of the start of home health services; or
 You have been seen in an acute or post-acute setting by a physician or
non-physician practitioner who has admitting and treating privileges in
the facility from which you were directly admitted to home health.

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