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Services
we can provide under your
Medicare
benefits:
Skilled
Nursing - our nurse can assess your health status,
help
you to learn self care such as wound dressings or
injections,
and/or teach you about a new disease or condition.
Physical
Therapy - our therapists
will come to your home
to
evaluate you and help you to learn and perform exercises
to
help you recover and regain your strength, recommend
medical
equipment if needed, work with you on your balance
and
posture and/or mobility and transferring.
Occupational
Therapist - our therapist will help you with
determining
what adaptive equipment you may need, assess
your
current limitations and design activities to help you
regain
your independence with activities of daily living, and/or
evaluate
your home for safety.
Speech
Language Pathologists -
our speech therapists
can
assist you with receptive/expressive communication,
cognitive
functioning, swallowing and/or speech training.
Home
Health aides – this service must be provided in
conjunction
with one of the above services. Our aides can
assist
you with bathing, dressing, and/or grooming for a short
time
while you recover.
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Cost
of Care:
These
services are provided at no cost to you if you have Medicare
part A.
We also participate with many
private
insurance carriers.
Frequently
Asked Questions
Q: Who can receive home health
care under their Medicare benefits?
A: Medicare has established criteria that individuals must meet to
be able to use their Medicare benefits:
- Patient must be homebound
- Patient must be under the care
of a physician who establishes and periodically reviews the
plan of care
- Care must be intermittent
- Care must be provided by a
skilled health care individual such as a Nurse or Physical
Therapists
- Care must be provided in their
place of residence
- Care must be medically
reasonable and necessary
Q: What does homebound mean?
A: Homebound means that it takes the patient considerable and
taxing effort to leave their place of residence. Absences must be
infrequent and of short duration. Individuals may attend religious
services and occasionally get their hair done. Someone may be
homebound for a short time. After a hospitalization most
individuals are home for a few weeks recuperating. They don't feel
like they have the energy to go out. They would be considered
homebound during that recovery time. Patients do not decide if
they are homebound. Their condition and ability determine this
status. You can be homebound while staying in someone else's home
as long as it takes considerable and taxing effort for you to
leave their home.
Q: Who can establish/oversee a
Plan of Care?
A: MDs, DOs or Podiatrists may establish the Medicare Plan of
Care. A Nurse Practitioner or Physician's Assistance may not
oversee a Medicare Plan of Care or order home health care to
start.
Q: What is considered
intermittent care?
A: Care, whether by a nurse or therapist, cannot be provided on a
daily basis except under limited and very specific circumstances.
Short duration of daily visit is permitted such as daily for a
weekly. This may be needed when caregivers are learning new skills
such as wound care or insulin injections.
Q: What is considered a
patient's place of residence?
A: The place of residence may not be a hospital, skilled nursing
facility, or intermediate care facility. It may be a group living
situation such as an Assisted Living Facility but services the
facility provides may not be duplicated by home health care.
Q: What does reasonably and
necessary mean?
A: According to Medicare, this means appropriate to the patient's
symptoms and in accordance with acceptable standards of care. It
cannot be provided for comfort or for custodial reasons. Many
times patients will need home health care after being diagnosed
with a new disease, when a pre-existing disease changes, or with a
new caregiver.
Q: If I receive home health care under my Medicare benefits,
how much will it cost me?
A: At the current time, there is no co-pay or cost for Medicare
home health care.
Q: What is the physician face to
face requirement?
A: Medicare now requires the physician, who will be signing the
Plan of Care, to see and examine the patient 90 days prior to the
start of home health care or 30 days after home health care has
been started. The doctor must then provide the home health care
agency with documentation of the care he/she feels is appropriate
and the reason the patient is homebound. If the physician is not
willing to provide this documentation, the patient will not
receive home health care.
Q: Is a visit by a nurse to
determine patient needs covered by Medicare?
A: No, these are called "evaluation" visits and they are
not covered under Medicare benefits.
Q: What about DME (Durable
Medical Equipment) and medical supplies?
A: Payment for DME, such as wheelchair, walkers, or mechanical
lifts, is not part of the home health care plan of care. The home
health care nurse or therapist will help the patient obtain needed
prescriptions from the physician. It is then the
patient's/caregiver's responsibility to obtain the equipment.
Medical supplies, such as wound care supplies or ostomy supplies
are covered under the homecare plan of care. Home health care
agencies are not required to furnish patients with specific
name-brand supplies but must provide them with a comparable
alternative.
Q: Can a nurse come and pre-fill
my medication box or get blood samples if my doctor orders those
things?
A: Yes and no. If you are receiving home health care for other
reasons, then those things can be done. If those are the only
things your physician wants the nurse to do, then Medicare will
not reimburse the home health care agency for those visits. You
may contract with a home health care company privately to do those
things.
Q: What if I'm not feeling well
and I just want a nurse to come out and check me, will Medicare
pay for that?
A: Not usually. The home health care agency will inquire to
determine if you meet the criteria to receive care under your
Medicare. If you do not, you may contract with a home health care
company privately for that care.
