Frequently Asked Questions

What is Home Health?

Home health involves services provided at home by nurses, therapists and aides are collectively termed as home health services. To qualify for services under Medicare and related plans clients must meet the homebound status criteria, and must be under a medical plan of treatment supervised by a physician. Criteria to qualify for home health services under Medicaid or other insurance plans differ from Medicare requirements.

 

What is meant by ”homebound” status ?

If you have Medicare and wish to receive home health services, you must meet certain qualifying criteria for Medicare to pay for your services. One of the criteria is that a person must be homebound”. While the word seems too restrictive, one need not be bedridden or wheelchair bound to be considered homebound. Medicaid and other private insurances do not require one to be “homebound” to receive home health services.

According to Medicare.gov, “homebound” is a status defined by conditions when:

    • Leaving your home isn’t recommended because of your condition.
    • Your condition prevents you from leaving home without help (wheelchair, walker, special transportation, or help from another person), and leaving takes a considerable and taxing effort.

A “homebound” client

      • May leave the home for medical treatment, for example: doctors’ visits
      • May leave the home for short, infrequent absences for non-medical reasons, like attending religious services, a short walk around the block, visiting a barber, etc.
      • You can also get home healthcare, if you attend adult day care.

In addition to homebound status, the other requirements for Medicare coverage are as follows:

        1. Your home health agency must be Medicare-certified.
        2. You must be under the care of a doctor, and be getting services under a plan of care established and reviewed regularly by a doctor.
        3. You must need, and a doctor must certify that you need intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational services.

*Note: services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, and an injectable osteoporosis drug. Please consult a representative for details specific to your situation.

 

What services are typically provided under Home Health?

SKILLED NURSING is provided by registered nurses and licensed practical nurses. Skilled services include assessments, patient education, blood draws, wound care, medication management and IV therapy. A nurse is on-call 24 hours a day, 7 days a week.

HOME HEALTH AIDES provide supportive nursing care under the supervision of a nurse. They provide assistance with personal care such as bathing, dressing, and also assist with walking and exercise, preparing light meals and maintaining light housekeeping. Aides do not administer medications but may remind clients when it is time to take medications.

PHYSICAL THERAPY is the health profession involved in the promotion of health, the prevention of disability and rehabilitation of clients through evaluation and treatment of conditions using agents such as manual techniques, short wave diathermy, ice, water, heat, paraffin, diapulse, laser, electrical stimulations, exercises, ultra-sound, etc.

OCCUPATIONAL THERAPY is the health profession involved in the treatment of various physical and mental disorders via occupation of the human mind and body in purposeful activities to promote functional independence. Occupational Therapy may use a variety of tools including exercises, adaptive devices, adaptations, orthoses, physical agent modalities, etc., to improve the functional performance components.

SPEECH LANGUAGE PATHOLOGY is the health profession involved in the evaluation and treatment of cognitive-linguistic/ communication disorders such as aphasia, dysphasia, dysarthria, etc., and, swallowing dysfunctions (dysphagia).

MEDICAL SOCIAL SERVICES involves counseling of clients on social and emotional factors, long and short-term financial planning, and provide information on community resourses.

 

What services does AmeriCare Home Health provide?

We provide a complete range of services inclusive of skilled nursing, physical therapy, occupational therapy, speech-language pathology, home health aide services and medical social work.

 

What is meant by the physician “Face-to-Face” requirement?

Under the Medicare or Medicaid program, a physician or an allowed non physician provider (NPP) must see a patient in person and document the encounter within the 90 days prior to, or the 30 days following, the start of home care services.

    1. These regulations pertain only to the initial 60 day episode of care. There is no need to have a new “face to face encounter” for the recertification (second and subsequent) episodes of care.
    2. Documentation of the “face to face encounter” must be done under the physician’s signature, even if the visit was done by an allowed NPP. If the visit was done by a NPP, that clinician must inform the physician of his/her findings for the purpose of documentation.
    3. “Face to face encounter” documentation must contain:
        • The reason (diagnosis or problem) that the patient was seen.
        • An explanation of how the need for home care relates to the reason for the visit.
        • An explanation of why the patient is “homebound”.
        • A statement of why skilled home care nursing or therapy is needed.
        • Physician’s signature (date stamp not allowed) and the date of the “face to face” encounter
        • If the patient is an inpatient, and a community physician will be signing the plan of care and overseeing home care, the name of this community physician must be noted on the documentation.
    4. The “face to face encounter” documentation cannot contain “standard language” or check boxes.

If you are a physician, please click here for information on the requirements from the American College of Physicians. Further guidance from CMS on the requirements for physician documentation of the Face-to-Face requirements may be obtained by clicking here.