The Choose Home Care Act of 2021 is a landmark piece of legislation for the home care community. If enacted, it would enable eligible Medicare patients to receive extended care services as an add-on to the existing Medicare Home Health benefit for 30 days post-discharge.
Full Answer
Can occupational therapists perform home health assessments under Medicare?
The new rule updates Section 484.55 of the home health conditions of participation to allow an occupational therapist to conduct the initial assessment visit and complete the comprehensive assessment under the Medicare program: When occupational therapy is on the home health plan of care, with either physical therapy or speech therapy, and
Why should I use Aota?
AOTA provides clear, easy-to-understand resources that will help you code and bill correctly. Still have questions? Watch these short videos to learn more about coding and billing.
How does home health care work with Medicare?
Usually, a home health care agency coordinates the services your doctor orders for you. Medicare doesn't pay for: 24-hour-a-day care at home. Meals delivered to your home. Homemaker services. Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need.
What is in-home care and does Medicare cover it?
In-home care (also known as “home health care”) is a service covered by Medicare that allows skilled workers and therapists to enter your home and provide the services necessary to help you get better.
Therapy Services After Payment Changes in SNFs: How to Show Your Value Within PDPM
AOTA members can register for a free, live webinar and Q&A hosted by Medicare staff and AOTA, APTA, and ASHA staff to provide an overview of how the new Medicare SNF PPS payment model, the Patient-Driven Payment Model (PDPM), may affect therapy practitioners working in the SNF setting.
Demonstrate Value of Therapy Services Before Home Health Payment Changes Begin
Watch a recording of a webinar and Q&A hosted by Medicare staff and AOTA, APTA, and ASHA staff. The webinar, which was recorded in August 2019, presents an overview of the new Medicare Home Health Prospective Payment System (PPS) payment model, the Patient-Driven Groupings Model (PDGM), going into effect January 1, 2020.
Video training resources
Watch these short videos to learn more about coding and billing. And access the resources below for tips on how to select the right codes.
More videos about coding and billing
Watch these short videos to learn more about coding and billing. And access the resources below for tips on how to select the right codes.
Occupational therapy evaluation and re-evaluation codes
Coding is essential not only for proper reimbursement, but also because it is used as a tracking tool by CMS and other agencies to inform how occupational therapy is practiced. These tips will help you select the most appropriate evaluation codes.
Diagnosis coding resources
The ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system, replaced the ICD-9-CM (9th Revision) on October 1, 2015. AOTA developed the following resources to help occupational therapists deal with the continuing challenges of ICD-10-CM.
CPT (procedural) coding resources
These tips will help you select the most appropriate intervention codes.
NCCI edits
The Medicare National Correct Coding Initiative (NCCI; also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Medicare Part B claims.
What is an ABN for home health?
The home health agency should give you a notice called the Advance Beneficiary Notice" (ABN) before giving you services and supplies that Medicare doesn't cover. Note. If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. ...
Who is covered by Part A and Part B?
All people with Part A and/or Part B who meet all of these conditions are covered: You must be under the care of a doctor , and you must be getting services under a plan of care created and reviewed regularly by a doctor.
What is a medical social service?
Medical social services. Part-time or intermittent home health aide services (personal hands-on care) Injectible osteoporosis drugs for women. Usually, a home health care agency coordinates the services your doctor orders for you. Medicare doesn't pay for: 24-hour-a-day care at home. Meals delivered to your home.
What is the eligibility for a maintenance therapist?
To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition , or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. ...
Does Medicare cover home health services?
Your Medicare home health services benefits aren't changing and your access to home health services shouldn’t be delayed by the pre-claim review process.
Do you have to be homebound to get home health insurance?
You must be homebound, and a doctor must certify that you're homebound. You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services.
Can you get home health care if you attend daycare?
You can still get home health care if you attend adult day care. Home health services may also include medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.
What Is In-Home Care?
In-home care (also known as “home health care”) is a service covered by Medicare that allows skilled workers and therapists to enter your home and provide the services necessary to help you get better.
What Parts Of In-Home Care Are Covered?
In-home care can cover a wide range of services, but they’re not all covered by Medicare. According to the Medicare site, the in-home care services covered by parts A and B include:
How To Get Approved For In-Home Care
There are a handful of steps and qualifications you need to meet to have your in-home care covered by Medicare. It starts with the type of help your doctor says you or your loved one needs and includes other aspects of care.
Cashing In On In-Home Care
Once you qualify for in-home care, it’s time to find the right agency who will provide you or your loved one services. The company you receive your services from is up to you, but they must be approved by Medicare in order for their services to be covered.
How To Pay for In-Home Care Not Covered By Medicare
There may be times when not every part of your in-home care is covered. We already know 20 percent of the durable medical equipment needed to treat you is your responsibility, but there are other services like custodial care or extra round-the-clock care that won’t be covered by Medicare. This is where supplemental insurance (Medigap) comes in.