As a top notch Home Health Agency, we are committed to caring for your medical needs. Our agency strives to provide medically necessary quality services with integrity and responsibility. Medicare, Medicaid, and most private insurance companies cover home health services for individuals who are confined to their homes and in need of skilled nursing care on an intermittent basis.
Other services such as physical therapy, speech-language pathology, occupational therapy, and medical social work are also covered by most payers. To qualify for coverage, a patient must be under the care of a physician who certifies the need for care and that the individual is confined to his/her home.
All services are provided under the supervision of a registered nurse. Skilled services require the orders of a physician. Services offered through this Agency are:
| Skilled Nursing | Speech Therapy |
| Home Health Aide / CNA Services | Social Worker |
| Physical Therapy | Infusion Therapy |
| Occupational Therapy |
Payment for home health services can be through Medicare, Medicaid, Health Maintenance Organizations (HMO), private insurance, Workers' Compensation, state contracts, or private pay. For some payer sources, the patient is not billed for any services. For example, Medicare Part A pays 100% of medically reasonable home health. Some payers require a deductible and a co-payment, including Medicare Part B. Some payer sources may require pre-certification and then may make a medical necessity determination based on clinical notes written by the person(s) providing the services. Some payer sources, including Medicare HMOs, may require pre-certification and limit the number and types of services we can provide.
Please be aware that certain
supplies such as those used for ostomies, may be covered
while you are cared for by the Home Health Agency. You
must notify the agency of any medical supplies you
are currently using. If you choose to pay for your
supplies yourself, you will be responsible for 100% of
the cost. Medicare and some private plans will not pay your supplier while you
are on a home health Plan of Care.
Any charges not paid by your
insurer will be discussed with you prior to rendering
services when possible. You, your
guardian, parent, caregiver or family member will be
informed in writing of all charges for services provided
and available methods of payment.
Your admission to home health
services depends on the reasonable expectation that your
medical, nursing, and social needs may be adequately met
in your residence. You are not admitted to the Agency
until an assessment of your needs has been completed and
you have given your consent for treatment. The Agency
must have orders from your physician (a Plan of Care)
before skilled care can be provided.
Some payers, such as Medicare,
require that you be homebound. "Homebound" means that
you have a normal inability to leave home.
For the purposes of the regulation, an individual
shall be considered confined to the home (homebound)
if the following two criteria are met:
1.
Criteria-One:
The patient must either:
-
Because of illness or injury, need the aid of
supportive devices such as crutches, canes, wheelchairs,
and walkers; the use of special transportation; or the
assistance of another person in order to leave their
place of residence
OR
-
Have a condition such that leaving his or her
home is medically contraindicated.
If the patient meets one of the
Criteria-One conditions, then the patient must ALSO meet
two additional requirements defined in Criteria-Two
below.
2.
Criteria-Two:
-
There must exist a normal inability to leave
home;
AND
-
Leaving home must require a considerable and
taxing effort.
To encourage greater involvement of
the physician in a patient's home health care services,
most insurance companies require that the patient
be seen face-to-face by the physician, or certain
non-physician practitioners working with the physician,
before home health services start or soon thereafter.
In many situations, these visits
with the doctor would have occurred just before the
start of home health care. Where that has not happened,
the patient must arrange to see his/her doctor or the
doctor who will be involved in the care provided in the
home. The key elements of this new
requirement is that the patient must have the
face-to-face visit within 90 days of home care starting
or within 30 days after the start of care. In addition,
the visit must be with the physician who is or will be
caring for the patient during the home health care
except for instances where the face-to-face encounter
occurred in a hospital and was performed by the
hospitalist. In this case the hospital physician
is responsible to convey his/her findings with the
physician who will sign your home health plan of care.
Finally, the encounter must be for medical services
related to the reason why home health
is needed.
Our agency can help determine whether the patient
has met the encounter requirement. The agency would need
a full list of all the doctors the patient has seen in
the 90 days before the start of home care. If none of
those doctor visits qualify, the agency needs to know
what doctor will be caring for the patient while on home
care.
Discharge Planning will be
initiated upon your admission to service. Services
will not be terminated until your physician has been
consulted and arrangements are made for continuing care,
if necessary. In most cases you will be given at least
five days notice before discharge. If you are admitted
to and remain in the hospital or other acute setting
over the end of your certification period you will be
discharged. When you are discharged from the hospital,
the Agency will readmit you or assist the hospital
discharge planner in making other appropriate care
arrangements for you.