Medicare Requirements Home Health Care

What You Need to Know – Medicare Requirements Home Health Care Services

When you or someone you love experiences a health care set back, if you have traditional Medicare as your insurance, you may qualify for skilled services at home. Understanding Medicare requirements for home health care is critical. Qualifying for Medicare home health care services needs to be arrange by a physician. A home health care order is required along with a homebound status.  To qualify for home health services, the beneficiary is required to have short term intermittent skilled nursing, physical or speech therapy services. Often times physicians will order a home health nurse after a visit to the hospital whether admitted or under observation status.  Home Health is a safe guard to make sure the patient is not readmitted to a hospital or skilled nursing and rehab facility.  Home Health Care may be ordered directly after a doctor’s office visit and does not require a hospital or skilled nursing and rehab stay.  It is important to note that a prescribing physician must have seen the patient face to face within the last 60 days and/or 30 days after home care is ordered.

Visiting Nurse is a Medicare Requirement Home Health Care

To qualify of Medicare Services, a skilled service is required. Medicare requires home health care be provided by a visiting nurse to treat a patient under Medicare requires reasonable and necessary treatment documented by an ordering physician.   The purpose  of the visiting nurse is to observe the patient in a home setting to make certain he/she is recovering comfortably at home or at a senior living community.

Skilled Nursing Care can be but is not limited to:

  • Medication Management
  • Wound Care
  • Catheters and Ostomy Care
  • Tube Feeding
  • Behavior Health and Therapy
  • Rehabilitation Nursing

Obtaining Physical, Occupational and/or Speech Therapy at Home

Just like skilled nursing services, therapy at home requires reasonable and necessary treatment of the patient’s illness or injury.   The goals are to help restore or maintain the functions affected by the patient’s illness.

Medicare Home Health Agencies will access patients during the initial start of care.  The initial start of care visit conducted by a registered nurse will review the current condition of the patient so to determine the need of a maintenance therapy program as it relates to their health condition.

home health care services

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