Medicare Conditions for Home Health Coverage

Caitlin Morgan

Oftentimes, a frustrating part of dealing with insurance is knowing how to qualify for the care you need. This knowledge is especially important when it comes to Medicare home health care coverage. If you provide home health care, part of your responsibility is to understand whether or not your patients may receive assistance from Medicare for the services you offer. Your knowledge of Medicare policies will allow you to provide the best care to your patients while also protecting yourself, as the experts at Caitlin Morgan assert.

Qualification for Coverage

In order to qualify for Medicare home health, the following must be true of the patient.

  • The patient requires skilled nursing and/or therapy services
  • The patient is homebound
  • The patient has a face to face visit with a doctor within 30 days of beginning home care or within 90 days prior to the start of care
  • The patient has a certification from a doctor confirming that he or she is homebound and in need of skilled care, along with an approved care plan
  • Care must be provided by a Medicare-approved home health agency

If all of these conditions are met, the patient can qualify for assistance for intermittent skilled nursing and therapy services, medical supplies, medical social services, a home health aide, and durable medical equipment. Your knowledge of this coverage and what is required to obtain it will make you a better home health care provider.