Medicare home health referrals must contain information in the medical record from the certifying physician and/or acute/post-acute care facility justifying the referral. Review this article/checklist to gain an understanding of the criteria necessary for home health referrals.
Medicare can allow some services by the attending physician, nurse practitioner, or physician assistant. This instruction provides an overview of Medicare payment when a patient elects their hospice benefit.
A revised MLN Matters® Special Edition article SE1436 on Certifying Patients for the Medicare Home Health Benefit is now available. Learn about patient eligibility and certification/recertification requirements.
In November 2018, the CMS finalized a new case-mix classification model, the PDGM, effective beginning January 1, 2020. The PDGM relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds.
Ordering physicians should be aware that HHAs may be adjusting, or planning to revise, their therapy services in response to fears about decreased reimbursement under the Patient-Driven Groupings Model (PDGM).
Providers billing Medicare should determine if a patient is enrolled in hospice before billing Medicare Part A. This article has tips on checking patient eligibility and avoiding hospice claim rejects.
A home health certification statement is an attestation that the Medicare beneficiary is eligible for home health services. It is a CMS requirement and condition of payment of the home health agency claim. This attestation can only be completed by the certifying physician.
This article explores how to address certain situations that may arise when ordering home health care for Medicare patients by presenting some solutions when caring for "Mary," our Medicare beneficiary.
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