If you are considering getting therapies or care with Medicare home health care medical service, you should know what the requirements are to be eligible. Once you know what the cost of Medicare insurance is, and what the FICA Med of the Medicare paycheck is, you will only need to learn about the requirements for coverage.
As you may know, as of March 2020, Medicare home health care allows certain allowed practitioners, in addition to doctors, to certify potentially eligible patients. Therefore, it is a little easier to get the required certification if you meet the established standards.
How do I know if home health care under Medicare can cover my application?
Before knowing if you meet the medical criteria to enjoy this service, it is necessary that you comply with some essential administrative steps for the use of this Medicare benefit.
Therefore, you must are enrolled in Part A, Part B Medicare, or both parts of the program. Likewise, you must have applied for coverage of this service and that the care you request is eligible for Medicare payment or reimbursement.
Another important point to be eligible to receive the Medicare home health care service is that the agency that provides the required care and therapies must be certified by this federal program.
Who qualifies for home health care services?
Receiving home health care can be as successful as being in a hospital or clinic and much less expensive. However, you must meet certain criteria to be eligible to take advantage of Medicare’s home health care services.
Among these criteria is that you must be under the care of a doctor or allowed practitioner (such as a nurse practitioner, clinical nurse specialist, or physician assistant). Furthermore, It is necessary that this care be included in a regular care plan with an “intermittent” frequency established by the specialist.
You also qualify if the specialist in charge of your care certifies that you need one or more of these therapies:
- Intermittent skilled nursing care (apart from drawing blood)
- Physical therapy
- Speech-language pathology services
- Continued occupational therapy
In addition, the specialist must make sure that your condition meets the definition of homebound. In addition, it is also necessary for the physician or other professional in charge of your care to record a visit within the required timeframes related to your request for home health care service.
What is homebound and who certifies it?
As you may already know, this is one of the eligibility criteria for Medicare to accept your application for home health care service. Homebound implies that you have mobility problems and there are two criteria for this:
- It is difficult for you to get out of the house without the help of someone or something because of an illness or injury. This applies to those who use wheelchairs, canines, or crutches. It also includes those who have been advised by their medical team not to leave home
- Leaving your home requires a great deal of effort and you only do so on special or specific occasions
This type of disability must be certified by a doctor or allowed practitioner, so you will be eligible for Madicare’s health care service.
Am I eligible if I meet all of these requirements and require Speech-language pathology service?
If you require Speech-language pathology services, physical therapy, and continued occupational therapy, you must meet specific requirements to be eligible for Madicare’s home healthcare service. The following criteria are taken into consideration:
- They are safe, effective, and specific to your condition
- They are sufficiently complex that they can only be applied by or under the supervision of a qualified professional
- They must be a specific amount, with a specific frequency and duration
Furthermore, keep in mind that they must meet one of two conditions: they are therapies that you need to return to your original state or improve the affected skills and functions, or you need a specialist to prevent your condition from worsening or to maintain it in the state it is in.
What happens if the specialist indicates that my care does not qualify as “intermittent”?
If the therapies and care you require must be performed on seven days and for more than eight hours a day for 21 days or more, you do not qualify for this service. For those who require full-time skilled nursing care for a considerably long period of time, you may not be eligible for home health care service.
However, if your doctor categorizes your care as “intermittent” and the care and therapy you require is less than eight hours a day within a 21-day period; but for some exceptional circumstances you must extend the period, Medicare will extend the period to a maximum of three weeks.
Home healthcare near me
You don’t know if there is a Medicare-certified Home Health Agency near your home? You don’t have to worry, because this federal benefit offers on its official website the option Find Home Health Services near me.
On this platform, you will be able to locate the agency that best suits your situation. In addition, it is an excellent tool that allows you to compare the quality of the different options available in the area where you live.
It is so easy to use that you only have to enter the ZIP code, state, street, or city where you are.
Once you hit the “search” button, you will be able to see the available options, contact information, and patient Medicare ratings.
On this website, you will also get data on doctors, rehabilitation services, and useful information certified by Medicare.
References
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CMSHHSgov. Medicare & You: Home Health Care. YouTube, https://www.youtube.com/watch?v=yuwA0t9Uwrk—. Medicare & You: Understanding Your Medicare Choices. YouTube, https://www.youtube.com/watch?v=WZVQSFBq2uw
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Haupt, Angela. “What Is Home Health Care & How Does It Work? – Forbes Health.” Forbes Health, Forbes, https://www.forbes.com/health/healthy-aging/what-is-home-health-care/
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“Medicare Home Health Benefit.” HHS, https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/MLN908143_2020_05_Medicare_Home_Health_Benefit_Booklet_Final.pdf
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“Medicare.Gov.” Welcome to Medicare | Medicare, https://www.medicare.gov/care-compare/?providerType=HomeHealth