Answer:  Medicare pays for health care in a patient's residence only if all of the following conditions are met:

1. The client must need intermittent skilled nursing care, phsyical therapy, speech therapy, or continuous occupational therapy
2. The client must be homebound *
3. The client is under the care of a phsyician who oversees home care necessity and treatment plans
4. Skilled services have a projected end date
   Example: If a client has had a wound for two years and is now referred to an agency, it may not be realistic that the wound will now heal. In this case the client may not be appropriate for home care.
   Example: It is expected that daily skilled nursing visits to provide wound care will end on (give a specific date that is reasonable). Significant wound healing will have occurred so that the skilled nursing visits can be reduced.
5. The client must be safe in the home environment

* On December 15, 2000, Congress passed a budget bill relating to Medicare. The new budget bill resulted in the following criteria changes in hombound status:

• Clients are also eligible for home care benefits if they attend an officially licensed adult day care
• Clients may attend religious services routinely

Answer:  If the conditions for eligibility are met, Medicare will pay for the following services in the client's home when they are medically reasonable and necessary:

1. Intermittent skilled nursing and certified nursing assistant services
2. Physical therapy, occupational therapy, and speech therapy
3. Medical Social Services

Answer:  If the conditions for eligibility are met, Medicare will pay for the following services in the client's home when they are medically reasonable and necessary:

1. Intermittent skilled nursing and certified nursing assistant services
2. Physical therapy, occupational therapy, and speech therapy
3. Medical Social Services

Answer:  Medicare Part B will reimburse for physical therapy, occupational therapy, and speech therapy if the following conditions are met:

1. Services are rendered to a beneficiary who has Part B of the Medicare benefit
2. Therapy is provided by a home health agency, skilled nursing facility, or rehab clinic
3. Therapy is ordered by the client's physician
4. Services are reasonable and necessary for the treatment of a client's illness or injury. Medicare reimburses 80% of the allowed charges after the Part B deductible is met. The client is responsible for the remaining 20% of the charges, which may be covered by the client's secondary insurance.

Under Part B, clients do not need to be homebound to qualify for these services.

Answer: 

Answer:  When the Medicare criteria for coverage of home health services are met, patients are entitled by law to coverage of reasonable and necessary home health services.

Answer:  Medicare does not "authorize" the number of visits a client will receive. Medicare recognizes that each client's individual care needs are different, and that a each client's needs must be taken into account when determining what type of care is reasonable and necessary. Therefore, it is not appropriate for services to be denied based solely on numerical data, diagnostic screens, or specific treatment norms.

Answer:  On admission, a standardized form, called an OASIS, is filled out. Some of the questions are highlighted in gray, and the answers to these questions result in the reimbursement amount an agency receives to provide services for that patient during a 60-day period (called an "episode"). If a patient requires less than 5 visits, Medicare then pays the agency per visit instead of per-episode.

Answer:  There is no requirement that the patient, family, or other caregiver be taught to provide a service if they cannot or choose not to provide the care. If a family member is available but unwilling to provide services, use of a home health agency to provide services would be reasonable and necessary.

Answer: 

• Routine supplies (non-billable) Supplies that are customarily used during the course of a home visit and are not designated for a specific patient.
  Example: Alcohol preps, cotton balls, tape, gloves, etc.
• Non-routine supplies (billable) The item is for a specific patient, the cost can be identified, and is ordered by the physician.
  Example: Dressing supplies, IV supplies, ostomy supplies, diabetic test strips
• Durable medical equipment (covered under Medicare Part "B", with a 20% co-pay) Medicare helps pay for the equipment if the item meets the following requirements:
  • Prescribed by a physician
  • Medically necessary
  • Addresses a medical need

Answer:  Yes. If a client is no longer homebound, therapy services can continue under the client's Medicare Part "B" benefit. A client may elect to continue the receive their therapy in the home or at an outpatient facility.