Home Health Final Rule 2018
How to Bill Medicare for Home Health Services
Medicare was enacted in 1965 to expand the Social Security Act by providing a hospital insurance program with supplemental medical benefits and extended medical assistance for the aged, survivors, and disabled, in addition to improving state public assistance programs. The insurance program is for people who have reached the age of 65 or have particular disabilities and those in the end stages of renal disease. Today, older Americans rely on it to pay for about half of all of their medical costs. One of the important provisions in Medicare coverage is home health care. This provision is intended to allow seniors to remain independent as long as possible. One study indicated that 90% of older Americans want to stay in their home as long as possible.Home treatment has been found to be less expensive, convenient, and often as successful as nursing home or hospital care. With the high financial costs of medical care, it is important to know how Medicare is billed for home health services.
Determining Eligibility for Home Health Care
Discuss your options with your doctor.Before you can be approved for home health care coverage, your doctor must decide that you need home care whereby a plan for care is prepared. If your doctor doesn’t determine that home care is necessary for you, Medicare won’t pay for it.
- The plan for your care must include at least 1 of 4 different services from nursing care, physical therapy, speech therapy, or occupational therapy.
Determine if you need only intermittent care with the planned service.Intermittent care means that you require care as little as once every 60 days up to as much as once a day for three weeks. If you need less or more care than this, you can’t qualify for this coverage.
- Skilled services include wound care for bedsores or surgical wounds, intravenous or nutrition therapy, injections, monitoring unstable health, and patient/caregiver education.
- In some cases, you can get coverage approval if you require daily care for longer than three weeks. But the extra time must be clearly established by a predictable definition for a finite period.
Determine if you are homebound.In order to gain coverage by Medicare for home health services, you must be considered homebound. Being “homebound” means that you require help from another person or some type of medical equipment (like a wheelchair, walker, or crutches) to leave your homeorthat your doctor thinks your health might worsen if you leave your home.
- Your doctor must certify that you are homebound by signing a home health certificate on your behalf.
Choose a home health care agency supported by Medicare.To qualify for home health care coverage, the home health agency servicing you must be approved by Medicare beforehand. Make sure you verify this before beginning your services with any care provided because you don’t want to get unexpectedly stuck with an entire bill because Medicare won’t cover the facility.
Billing Medicare for Home Health Care
Have the home health agency submit your claims to Medicare for payment.As with most other types of medical insurance, claims for payment for services rendered must be directly submitted to Medicare by the home health agency.
Understand the bill/charges.You should receive an itemized list of all services being billed to Medicare. Make sure you read it thoroughly and check it for any possible mistakes. While it is true that the home health agency should make sure all charges and bills are correct ahead of time, mistakes do occasionally happen and it is your responsibility to ensure that everything is correct with your billing account.
Pay the balance.Since Medicare pays for a percentage of some services and doesn’t cover other services at all, it is possible that you will receive a bill in the mail for any charges that you are responsible for paying out-of-pocket. Watch for the bill in the mail and pay any outstanding balances as soon as you’re able.
- Failure to pay your portion could result in disruption of your Medicare services in the future.
Understanding the Types of Medicare Coverage
Understand the types of Medicare coverage.Medicare has four parts, although Parts C and D are optional and are run through private insurance companies. Most people receive Medicare Part A upon reaching the age of 65.
- Provided you paid into the system while working, there are no premiums required for Part A coverage which includes coverage for hospitalization; some skilled nursing facilities, which are not custodial or long term; hospice; and health care which includes some home health care.
- Medicare Part B is optional and it requires a premium. It focuses on doctor's services, outpatient care, therapy, and some home health care.
- Medicare Part C, known as Medicare Advantage, allows for individuals to purchase elective plans run by private insurers who provide additional coverage that includes the benefits of Medicare Part A and Part B. However, the plans do have limits on how and where members receive care. It is also possible that your doctor is not in the plan's network which could complicate your home health services or increase your cost.
- Medicare Part D also includes the option to purchase private insurance which in this case partially covers prescription drug costs.
Know what constitutes a covered expense for Medicare.In addition to the above services, Medicare will pay for some medical social services which evaluate social and emotional needs and provide the necessary counseling, medical supplies, and up to 80% of approved medical equipment.
- Coverage for the home care services will continue as long as they are considered medically reasonable and necessary.
Understand what Medicare will not cover.There are a few things that are often included as part of normal home health care services that Medicare will not cover. It is important for you to know what these services are so that you can realize what you will be covering out of pocket if you choose some of these services. Some services not covered by Medicare include:
- Housekeeping services
- Full-time nursing care
- Meals delivered to your home
- Drugs and biologicals administered at home
- Personal care from a home health aide if this is the only type of care you need
Get a home health care aide.Medicare will cover the full cost of a home health aide if skilled services are required. Skilled services include physical, speech, or occupational therapists; wound care; and other services that may require 24 hour monitoring or care.
- Your home health aide will assist you with personal care services like using the toilet, bathing, and dressing. However, if youonlyneed personal care service, Medicare willnotcover the costs. You must require skilled services as well.
QuestionWill Medicare pay for someone to visit daily to check vitals and make sure medications are taken?wikiHow ContributorCommunity AnswerYes. You will have to take the patient to their PCP first and get a "face to face visit" for the specific purpose of getting home health. Then the doctor has to order the home health. A home health nurse will go to the patient's home to evaluate the need and to determine what home health services the patient qualifies for.Thanks!
QuestionDoes medicare pay for home blood draws?wikiHow ContributorCommunity AnswerMedicare will compensate for blood extractions so long as they are related to your physician's need for laboratory results. Blood donations do not qualify for Medicare coverage.Thanks!
QuestionHow much does Medicare pay a month?wikiHow ContributorCommunity AnswerIt depends on your specific location, age and financial bracket.Thanks!
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Video: Medicare Billing Guidelines | Medicare Parts A, B, C and D
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