Determining Medicare Eligibility for Home Health Services

Before providing home health services that will be reimbursed by Medicare, it’s important for agencies to determine Medicare eligibility. Having the tools you need to verify Medicare eligibility and provide quality care allows you to put patients before paperwork.

What Determines Medicare Eligibility?

Medicare eligibility for home health services requires the following criteria to be met:

  • The patient must be receiving services under a care plan established and reviewed regularly by a doctor.
  • The patient must need either intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy.
  • The home health agency must be approved by Medicare.
  • The patient must be homebound, meaning the medical condition keeps him or her from leaving home without help or takes considerable effort.

Eligibility is also based on the amount of services a patient needs. Medicare defines “intermittent” nursing care as services that are given on fewer than seven days a week or less than eight hours a day over a period of 21 days. There are a few exceptions to this rule in special circumstances, like when a doctor can predict when the need for when home health services will end.

What Home Health Services Aren’t Covered by Medicare?

Medicare won’t cover everything. Below are a few examples of services that won’t be covered:

  • Meals delivered to a patient’s home.
  • 24-hour-a-day care at home.
  • Homemaker services (shopping, cleaning, laundry, etc.) when these services aren’t related to a patient’s plan of care.
  • Personal care provided by home health aides (bathing, dressing, using the bathroom) when this is the only care a patient needs.

HEALTHCAREfirst, the industry leading provider of EHR software for home health and hospice, coding and billing services, and advanced analytics can help your home health agency provide Medicare-approved services to patients in need.We are your anywhere, anytime connection between field nurses and the information and resources they need to provide attentive care to their patients. Contact us today.

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