In order to qualify for home health services under Medicare, the patient must:
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Be eligible for Medicare benefits
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Be under the care of a physician who establishes and periodically reviews the plan of care
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Require skilled nursing on an intermittent basis or physical, speech, or occupational therapy for ongoing services
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Require services reasonable and necessary for treatment of the illness or injury
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Be homebound
How Do Patients Qualify?
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What does "homebound" really mean? Medicare defines it as: "absences from the home are infrequent, of short duration, a taxing effort or, to receive medical care."
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What is a “qualifying skilled need”? If a patient has one of the diagnoses listed above, that is the skilled need. Any need for a Registered Nurse or Registered Therapist qualifies.
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Does the patient need to be recently discharged from a facility? No. But a Medicare Certified Agency must have a physician's agreement to sign orders.
Medicare reimburses approved home care at 100%.
NOW MEDICARE REMBURSES THE PHYSICIANS ALSO:
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USING CODE G0180: MEDICARE ALLOWABLE IS $56.51 for cert.
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USING CODE G0179: MEDICARE ALLOWABLE IS $43.32 for recert.
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USING CODE G0181: MEDICARE ALLOWABLE IS $113.62 for CPO.