Palmetto GBA Railroad
Medicare (original Medicare) covers Part B services, such as doctors’ visits,
surgeries, preventive services, lab tests and some ambulance transports or
services furnished by other non-practitioners or suppliers.
Home health is a covered service under the Part A Medicare benefit. It consists
of part-time, medically necessary skilled care (nursing, physical therapy,
occupational therapy, and speech-language therapy) that is ordered by a
physician.
In order to be eligible for Home Health Care, you must be 'homebound' and a
doctor certifies that you are homebound. Being homebound means that:
• Leaving your home isn’t recommended due to your
condition (you are confined to your home)
• You are unable to leave home without help (such
as by using a wheelchair or walker, needing special transportation, or getting
help from another person)
• Leaving home takes a considerable and difficult
effort
Other requirements for Home Health Care:
• You are under the care of a physician
• You receive services under a plan of care that
was created and is reviewed on a periodic basis by a physician
• You are in need of skilled nursing care on an
intermittent basis, or you need physical therapy or speech-language pathology
services; or you have a continuing need for occupational therapy after your
need for skilled nursing, physical therapy or speech-language pathology has
ended
• If your only need is for skilled oversight of
unskilled services (a long way of saying the management and evaluation of the
care plan established for you), then your doctor must include a statement that
explains how Home Health Care is clinically and medically necessary for you
The doctor that creates the plan of care and certifies that you need Home
Health Care must be enrolled with Medicare. They must also be a doctor of
medicine, osteopathy or podiatric medicine. They have to certify that you are
receiving Home Health Care under their care.
Your doctor must certify that you need Home Health Care when the plan of care
is created, or very soon after that. The certification has to be signed and
dated by the physician that created your plan of care, and this must be
completed before a home health agency bills Medicare.
Home health services include skilled nursing care (on a part-time or
intermittent basis). They must be medically necessary and ordered by your
doctor and provided by a registered nurse (RN) or a licensed practical nurse
(LPN).
Skilled nursing care can include giving IV drugs or shots, changing wound
dressings, tube feedings, etc. Services that can be safely given by you
yourself or by a non-medical person without nurse supervision are not
considered skilled nursing care.
Other covered home health services include physical therapy, occupational
therapy, and speech-language pathology services when deemed medically necessary
as long as one of the following applies:
• Your doctor expects your condition will improve
in a reasonable and fairly predictable period of time
• You need a skilled therapist to safely and
effectively create a maintenance program or to perform maintenance therapy
As with all covered Medicare services, the number, frequency and duration of
these services must be medically necessary and reasonable.
Home Health Care can also help pay for medical social services when they are
ordered by your doctor to help you with social or emotional difficulties
related to your illness. It also can assist with paying for medical supplies,
such as wound dressings, when they are ordered as part of your care.
Home Health Care doesn’t cover everything. Some things which are excluded
from this program include 24-hour day care at your home, meals delivered to
your home, shopping/cleaning/laundry assistance and other non-skilled custodial
care when these services are not related to your plan of care.
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