Affinity Home Health Care is a licensed and certified home health agency. What this means to you as a potential client for home health care is that regardless if you have Traditional Medicare or one of the Medicare Advantage plan the agency has to comply with Medicare guidelines for your care. This means you will receive the same services as our Traditional Medicare clients. Whether a Traditional Medicare or Medicare advantage plan they are billed the same. Home Health care is billed on

Medicare part A. 

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Medicare guidelines:

1. A physician has signed or will sign a care plan, certifying that the services are medically necessary; the physician must also certify that there has been a face-to-face encounter with the patient’ within 90 days prior to the start of care or within 30 days after the start of care.

2. The patient is homebound. This criterion is generally met if non-medical absences from home are infrequent and leaving home requires a considerable and taxing effort, which may be shown by the patient needing personal assistance, or the help of a wheelchair or crutches, etc. Attendance at an adult day care center or religious services is not an automatic bar to meeting the homebound requirement.

3. The patient needs skilled nursing care on an intermittent basis (less than 7 days per week but at least once every 60 days) or skilled physical therapy, speech therapy, or continuing occupational therapy.  Daily skilled nursing care is available for periods of 21 days or less (with extensions in exceptional circumstances when the need for additional daily skilled nursing is finite and predictable).

4. The care must be provided by, or under arrangements with, a Medicare-certified provider.

 

Coverable Home Health Services:

If the triggering conditions above are met, the beneficiary is entitled to Medicare coverage for home health services. There is no coinsurance or deductible. Home health services include:

• Part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse;

• Physical, occupational, or speech therapy;

• Medical social services;

• Part-time or intermittent services of a home health aide, and;

• Durable medical equipment (DME) and medical supplies

1. Medicare coverage should not be denied simply because the patient's condition is "chronic" or "stable." "Restorative potential" is not necessary.

2. There is no legal limit to the duration of the Medicare home health benefit. Medicare coverage is available for medically necessary home care even if it is to extend over a long period of time.

3. The doctor is the patient's most important ally. If it appears that Medicare coverage will be denied, ask the doctor to help demonstrate that the criteria above are met. Home care services should not be ended or reduced unless it has been ordered by the doctor.

With our aging population we are facing a big shortage of healthcare workers and nursing staff which has resulted in, early discharge from hospitals, cutbacks on rehabilitation which will make the need for home health care admissions for services within 24-48 hours of a referral a top priority.  As the Home Health Care industry continues to progress there will be a big need for this service more than ever in the next few years.  A lot of times when clients come out of the acute care environment they are so exhausted and happy to be home they are not aware that they are at very high risk of readmission to acute care setting within those first 24-72 hours especially when they go back to old habits that caused them to end up in the acute setting to begin with.

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If home health agencies do not set these admissions within 24-48 hours and ensure that the client and caregivers understand what the consequences will be if they do not comply in getting service implemented, then client will potentially end up back in the acute care setting. This type of situation where client ends up back in the acute care setting will have a negative effect on the hospitals, rehabilitation facility, doctors and the home health agency.

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