How to Bill Medicare for Home Health Services
Medicare was enacted in 1965 to expand the Social Security Act by providing a hospital insurance program with supplemental medical benefits and extended medical assistance for the aged, survivors and disabled, in addition to improving state public assistance programs. The insurance program is for people who have reached the age of 65 or have particular disabilities and those in the end stages of Renal Disease. Today older Americans rely on it to pay for about half of all of their medical costs. One of the important provisions in Medicare coverage is home health care. The provision is intended to allow seniors to remain independent as long as possible. One study indicated that 90% of older Americans want to stay in their home as long as possible. Home treatment has been found to be less expensive, convenient and often as successful as nursing home or hospital care. With what is at stake it is important to know how Medicare is billed for home health services.
Understand the best options for your Medicare coverage. Medicare has 4 parts although Parts C and D are optional and are run through private insurance companies. Most people receive Medicare Part A upon reaching the age of 65. Provided you paid into the system while working, there are no premiums required for Part A coverage which includes coverage for hospitalization, some skilled nursing facilities, which are not custodial or long term, hospice and health care which includes some home health care. Medicare Part B is optional and it requires a premium. It focuses on doctor’s services, outpatient care, therapy and some home health care.
Determine whether you are eligible for home health care. There are 4 criteria that must be met for eligibility.
- Your doctor must decide that you need home care whereby a plan for care is prepared. The plan must include at least 1 of 4 different services from nursing care, physical therapy, speech or occupational therapy.
- You need only intermittent care with the planned service.
- You need be basically home bound.
- The home health agency servicing you must be approved by Medicare.
Know what a covered expense is for Medicare. In addition to the above services, Medicare will pay for some medical social services which evaluate social and emotional needs and provide the necessary counseling, medical supplies and up to 80% of approved medical equipment. However, full time care, self administered drugs, personal care and homemaker services are not likely to be covered. Coverage for the home care services will continue as long as they are considered medically reasonable and necessary.
Have the home health agency submit your claims to Medicare for payment.