The Role of Medicare in Home Based Health Care

Home based health care, in Medicare terms, may include medical social services, part-time or intermittent home health aide services, medical supplies provided for use at home, durable medical equipment, or injectable osteoporosis drugs. Additionally, physical therapy, speech-language pathology services, and continued occupational services are covered. It is generally a home health care agency’s duty to coordinate these services for their patients as they are ordered by the patients’ doctors. Eligible home care services are covered by Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance).

Eligible individuals and their families often don’t realize how much Medicare benefits can save them. A 2012 study revealed that more Medicare savings exist in home health care than in any other post-acute care option. This study, conducted by consulting group Dobson DaVanzo and Associates on behalf of the Alliance for Home Health Quality and Innovation (AHHQI),  aimed to determine just how the Medicare home health benefit could better meet beneficiary needs, plus improve the efficiency and quality of the care provided within the U.S. healthcare system.

Home Healthcare as a Patient’s First Option

The AHHQI study used claims data for a common Medicare Severity-Diagnosis Related Group (MS-DRG), which is a system of classifying a Medicare patient’s hospital stay into various groups in order to facilitate payments of services. The MS-DRG used for the study’s claim data came from major joint replacement procedures, and found that those patients saved Medicare $5,411 each when compared with the average Medicare post-acute care episode payment, if home health care was used as the first post-acute care setting.

Does Medicare Cover All Aspects of Home Health Care?

According to Medicare.gov, although Medicare Part A and/or Part B do cover many types of home care services, Medicare does not currently reimburse for the following services:

  • 24-hour home care
  • Meal delivery to patient’s home
  • Homemaker/Housekeeping services
  • Non-Medical personal care

Are All Home Care Patients Eligible for Medicare?

All patients with Medicare Part A and/or Part B (who meet the eligible conditions) are potentially eligible for Medicare and Medicare savings. However, such patients must be under the care of a doctor, and they must be getting services under a plan of care established and reviewed regularly by a doctor, according to Medicare.gov. Said doctor must also certify that the patient needs intermittent skilled nursing care (besides drawing blood) and/or physical, speech, or occupational therapy on a continual basis.

In addition, the home health agency caring for the patient must be “Medicare-certified”, and the patient must be homebound, which a doctor would also need to verify.  Medicare certified means that the agency has met certain criteria…please add a couple of sentences here explaining what med cert is for the agency…

The Role of the Home Health Care Agency

A home health care agency has a duty to their patients to keep them informed on how much Medicare will pay towards their services. They also have the responsibility to tell the patient if any items or services they may be providing are not covered by Medicare, and how much the patient will be expected to owe. This information should be given both verbally and in writing, via a notice called a “Home Health Advance Beneficiary Notice” (HHABN), in order to reduce that agency’s liability exposure.

At Manchester Specialty Programs, we understand that running a home care agency is not easy. As changes take place within this industry and with health care delivery overall, it’s imperative for these agencies to ensure they are financially protected from any legal claims that may occur.

Our comprehensive home health care and hospice provider insurance program is designed to help home care agencies continue to provide the important services they offer throughout our communities. We deliver specialty insurance programs that are specifically designed for home care and hospice firms in both medical and support roles. To find out more about our operation and all our specialty insurance programs, you or your local insurance broker can give us a call today at 855-972-9399.