You’ve just started a home health business. You’re wondering how to bill Medicare for home health services. Here’s a quick guide.
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Medicare coverage for home health services has evolved over the years. Currently, Medicare pays for home health services that are reasonable and necessary for the treatment of an illness or injury. The covered services must also be provided by a Medicare-certified home health agency.
What is home health care?
Home health care is a set of services that are covered by Medicare that can be provided in your home. These services are typically for people who are discharged from the hospital but still need some level of care. Home health care can include things like skilled nursing care, physical therapy, occupational therapy, and more.
What are the benefits of home health care?
There are many benefits to home health care, but the three most important are that it is cost effective, it helps people heal faster, and it allows people to stay in their homes.
Home health care is less expensive than traditional nursing home care or hospital care. It is also more convenient because people can receive care in their own homes. In addition, home health care allows people to heal faster because they are in a familiar environment and they have the support of family and friends. Finally, home health care allows people to stay in their homes instead of being admitted to a nursing home or hospital. This is important because it allows people to maintain their independence and dignity.
Who is eligible for home health care?
Medicare defines home health care as skilled nursing and rehabilitative therapy services that can be provided in the patient’s place of residence. These services are generally provided by a home health agency after a doctor has determined that the patient is homebound and in need of skilled nursing care or rehabilitative therapy.
In order to be eligible for Medicare-covered home health services, patients must meet the following criteria:
-A doctor must certify that the patient is homebound, meaning that due to illness or injury, leaving home takes a considerable and taxing effort.
-The doctor must also certify that the patient requires skilled nursing care or rehabilitative therapy. This means that the patient needs services or treatments that can only be provided by a licensed nurse or therapist.
-The patient must receive care from a Medicare-certified home health agency.
How to bill Medicare for home health services?
You can bill Medicare for home health services rendered to a patient in two ways, through a Medicare-certified home health agency (HHA) or through a personal care services agency (PCSA). To be eligible for reimbursement, the services must be ordered by a physician and meet all other Medicare requirements.
If you choose to bill Medicare directly, you will need to submit a claim form along with documentation of the services rendered. The documentation must include the patient’s name, address, dates of service, and diagnosis. You will also need to include your name and National Provider Identification number on the claim form.
If you opt to use an HHA or PCSA to bill Medicare on your behalf, you will still need to provide them with documentation of the services rendered. The HHAs and PCSAs will then submit the claims to Medicare on your behalf and reimburse you for their services.
What are the home health care services covered by Medicare?
Medicare covers a wide range of home health care services. These services are typically provided by home health agencies, which are approved by Medicare. Some of the services that Medicare covers include:
-Skilled nursing care
-Home health aide services
-Medical social services
-Transportation to and from medical appointments
How much does Medicare pay for home health services?
The Centers for Medicare and Medicaid Services (CMS) released a final rule that updates payment policies and rates for Medicare fee-for-service (FFS) home health services furnished to beneficiaries during calendar year (CY) 2020.
The final rule implements required statutory changes, such as the Bipartisan Budget Act of 2018’s adjustments to the home health case-mix weights and the Patient-Driven Groupings Model (PDGM). In addition, the rule finalizes home health quality reporting requirements for the CY 2020 performance period of the Home Health Quality Reporting Program, and it finalizes several policies to promote innovation and flexibility in care delivery, including a new optional telehealth benefit for home health agencies participating in demonstration projects.
According to the final rule, Medicare will pay home health agencies $28.6 billion in 2020, which is an increase of $940 million, or 3.4 percent, compared with 2019.
How to find a home health care agency?
You can find a home health care agency in your area through the Home Health Compare tool on Medicare.gov. This website lets you compare agencies side-by-side, so you can see which ones have the services you need and read reviews from other patients.
In conclusion, billing Medicare for home health services can be a daunting task. However, if you follow the steps outlined in this article, you should be able to submit a claim without too much trouble. Be sure to keep accurate records of all communications with Medicare and your home health provider, and don’t hesitate to ask for help if you need it.