geriatrics
Home Health Care
Reimbursement for home health care
Few patients with a serious, chronic disorder can afford full-time home care even though most would prefer to remain at home. Medicare covers some home care services for patients who are unable to leave their home, but it has certain requirements, which depend on the Medicare option chosen. Some private insurance companies cover some home health care services (eg, infusion services) for patients who are able to leave their home. For patients’ care to be reimbursed by a third party, physicians must certify that home care is required and, for Medicare, that patients meet Medicare requirements for home care. Medicare requires that home health care agencies tell patients which services are reimbursable. Home care services that are delivered are based on a detailed assessment (Outcome and Assessment Information Set [OASIS]) that is completed by a registered nurse or therapist when the patient is admitted to Medicare. Third-party payers are increasingly limiting personal services to control costs. Home health care agencies are directly reimbursed by Medicare, Medicaid, or private insurers. 