Before a patient may use Medicare to pay for home health services, they must meet CMS eligibility criteria
- Face to face encounter with the certifying physician or non-Physician practitioner (Nurse Practitioner, Physician Assistant, CNM & CNS)
- Must be confined to the home
- Need intermittent skilled services SN, PT, OT, SLP
- Be under the care of a Physician on non-Physician Practitioner while patient is receiving home health services
- Have a Plan of Care ordered and reviewed by certifying physician or non physician practitioner.
Face to face Encounter Requirement
- Must be done by certifying physician or non-Physician Practitioner.
- Must be done 90 days before or within 30 days after the start of home health services.
- Must be related to primary reason the patient needs home health services.
- Must be documented in the Patient medical record which is a proof that the visit occurred and also on the home health certification.
- Documentation must support eligibility for home health services including need for skilled services and home bound status.
- Documentation must be dated and sign by the certifying Physician or non-Physician Practitioner.
Certifying Physician or non-Physician Practitioner must be enrolled in the Medicare Program.
Must be a Doctor of Medicine or a Doctor of Osteopathy or a Doctor of Podiatric Medicine.
Must not have financial relationship with Home Health Agency unless it meets one of the exceptions in 42 CFR 411.355-42 CFR 411.357.
Non-Physician Practitioner that works in collaboration with the certifying Physician such as Nurse Practitioners, Clinical Nurse Specialists can perform Face to Face evaluation as well as Physician Assistants that are under the supervision of the certifying physician.
Non-Physician Practitioner must document their Face to Face encounter evaluation in the patient’s medical record and communicate clinical findings to the certifying physician who has the SOLE responsibility to order Home Health Services, certify Face to Face encounter occurred and that Patient met Medicare eligibility requirement for home health services.
Home Bound Status Requirement
- Leaving home must require a considerable and taxing effort or there must exist a normal inability to leave home
- Patient uses assistive devices such as cane, wheel chair, walker, crutches due to illness or injury; uses special transportation or need assistance of another person to leave their place of residence or have medical condition such that leaving his or her is medically contraindicated.
Documentation for Home bound status
The certifying physician on non-physician practitioner will explain in detail
- how patient’s condition makes leaving home contraindicated,
- difference between patient normal ability versus normal inability,
- exactly what effects are causing the considerable and taxing effort for patient to leave home,
- patients’ illness or injury (patient diagnosis, duration of illness, clinical course such as improvement or worsening, prognosis, nature and extent of functional limitations and other therapeutic intervention), the type of support, assistive device that patient needs to leave home,
- document clinical finding that support patient home bound status in the medical record and certification form.
Note that patient can still be home bound, If patient leaves home infrequent or for relatively short duration for health care treatment such as medical appointment or for religious services or to attend adult daycare centers for medical care or for other unique or infrequent events such as funeral, graduation or hair care.
Need for Skilled Services
The Certifying physician or non- physician practitioner will specify skilled services that will be provided to patient at home and also the frequency of skilled services as well as explanation why skilled services are needed.
Services that Medicare patients may receive at home include
- Skilled Nurse on an intermittent/part time basis
- Home health Aides on an intermittent/part time basis
- Physical therapy
- Occupational therapy
- Speech Language pathology
- Social work
Plan of Care, Under the Care of a Physician or Non-Physician Practitioner
- Medicare requires patient to be under the care of a physician or non-physician practitioner who will sign the certification and plan of care of the patient.
- The expectation is that the certifying physician or non-physician practitioner that certify patient’s eligibility for home health services will be the same physician that instituted and sign the plan of care.
- If the certifying physician is an acute /post-acute care physician and will not be be following the patient while patient is receiving home health services, then the medical record documentation must identify the name of community physician who will be monitoring patient home health services and sign the plan of care.
Medical Conditions That Warrant Home Health Services
- Infectious & Parasitic Diseases
- Neoplasms or Cancers
- Endocrine, Nutritional, & Metabolic Diseases & Immunity Disorders
- Diseases of the Blood & Blood-Forming Organs
- Mental Disorders
- Diseases of the Nervous System & Sensory Organs
- Cardiovascular Diseases
- Congestive Heart Failure
- Respiratory Diseases
- Chronic Obstructive Pulmonary Disease & Related Conditions
- Diseases of the Digestive System
- Urinary Diseases
- Diseases of the Reproductive System
- Skin Disease
- Diseases of Subcutaneous Tissue
- Diseases of the Connective System
- Diseases of the Musculoskeletal System
- Orthopedic Disorders
Services We Provide
Pro-Stars Health Care LLC offers the following home healthcare services:
- Medication management and education for a new or changed medication
- Skilled observation and assessment of newly diagnosed conditions or a worsening existing condition
- Complex wound care
- Bowel and bladder incontinence training
- Diabetic self-management training
- Assistance with ostomy and catheter care
- Assistance and education with feeding and nutrition
- Management and evaluation of care plans
- Evaluation and diagnosis
- Language disorder treatment
- Auditory rehabilitation
- Cognition evaluation and interventions
- Voice disorder treatment
- Speech articulation disorder
- Dysphagia treatment
- Training for Activities of Daily Living
- Neuromuscular re-education
- Fine motor coordination
- Perceptual-motor training
- Adaptive equipment
- Sensory treatment
MEDICAL SOCIAL SERVICES
- Short-term counseling for long-term planning and decision-making
- Assessment of social and emotional factors
- Short-term therapy
- Community resource planning
HOME HEALTH AIDE
- Light housekeeping
- Light meal preparation
- Support nutritional needs
- Personal Care
- Bathing and dressing
MEDICAL SUPPLIES & EQUIPMENT
We provide assistance in arranging supplies and equipment for the patient’s unique medical needs.
- Therapeutic exercise
- Transfer and gait training
- Prosthetic training
- Home exercise program
- Ultrasound and other modalities