In order to qualify for home health services under Medicare, the patient must:

  • Be eligible for Medicare benefits

  • Be under the care of a physician who establishes and periodically reviews the plan of care

  • Require skilled nursing on an intermittent basis or physical, speech, or occupational therapy for ongoing services

  • Require services reasonable and necessary for treatment of the illness or injury

  • Be homebound

How Do Patients Qualify?

  • 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."

  • 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.

  • 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:

  • USING CODE G0180:  MEDICARE ALLOWABLE IS $56.51 for cert.

  • USING CODE G0179:  MEDICARE ALLOWABLE IS $43.32 for recert.

  • USING CODE G0181:  MEDICARE ALLOWABLE IS $113.62 for CPO.

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