Home Health Care: General Reference Guide

Provided as part of the Community Education Program of Tar Heel Home Health

Most frequently referred diagnosis to home health:

• Angina

•

Bipolar
• Burns
• CAD
• Chronic Airway Obstruction
•

Congestive heart failure
• CVA
• Diabetes
• Decubitus Ulcer

•

Depression
• Dysphasia
• Hypertension
• Neurogenic bladder
•

Open wounds
• Osteoarthritis
• PVD
• Schizophrenia
• Senile

osteoporosis
• Total knee replacement
• Total hip replacement

• Urinary incontinence

If your patient has an exacerbation of a pre-existing condition, acute onset of

a new diagnosis or new medication, home health services could be covered 100%

by Medicare if the patient meets the eligibility requirements.

Home Health Services may include:

• Assessment

• Catheter maintenance

• Dressing changes

• Enteral/parenteral therapies

• Infusion therapy

• Instruction on disease management

• Lab work

• Medication instruction

• Monitoring

• Nutrition

• Ostomy management

• Pain management

• Wound care Home health provides: Skilled nursing services

• Enterostomal therapy

• Mental health nursing

• IV therapy

• Physical therapy

• Occupational therapy

• Speech therapy

• Medical social worker

• Home health aides Medicare guidelines and patient eligibility requirements.

Medicare will pay for the unlimited number of visits and no coinsurance

met:

• Patient must be enrolled in the Medicare program during the time services

are provided.

• A Medicare certified agency must provide services.

• A physician who establishes and periodically reviews the order at least

every 60 days must order the services.

• Services must be provided in the patient’s place of residence.

• Patient must be homebound.

• The services must be medically reasonable and necessary to the treatment

of an illness or injury.

• The patient must need a qualifying skilled service (Skilled nursing,

physical therapy, speech language therapy) on an intermittent basis, or for

continuing care occupational therapy.

• If at least one of the qualifying services is needed, Medicare may also

pay for the following: home health aide services, medical social services, medical

supplies, durable medical equipment and supplies.

Homebound Medicare defines an individual as homebound if he/she:

• Has a normal inability to leave home due to illness or injury (not just

due to weakness and feebleness or old age).

• Experiences a considerable and taxing effort to leave and trips are

for: Medical treatment, attending religious services, to attend a licensed adult

day care,

• Infrequent OR short duration for social purposes.

Homebound eligibility is not affected by frequent absences from

the home when the reason for leaving is to receive medical care,

provided the home health services could not be reasonably provided

by the other medical providers outside the home.

An individual would not be considered homebound if he/she:

• Leaves the home frequently for social activities even though it requires

a considerable and taxing effort.

• Goes to a nonlicensed or certified daycare center for non-medical purposes

or to a relative’s house part of the time.

• Leaves home against physician’s orders, if this is done frequently

and/or for long periods of time.

• Leaves home for shopping or business on a regular basis.