Medicare Admission Requirements for Home Health

• The patient is an eligible Medicare beneficiary
• The service must be ordered by a physician
• The service must be reasonable and necessary in the treatment of the illness or injury
• The patient must be homebound*
• The patient must require a qualifying skilled service

When all the above conditions and criteria are met, Medicare will reimburse for an unlimited number of visits.

Outline of Medicare Benefits:

Part A (Hospital Insurance) will pay for unlimited home health care visits if:

• Services are ordered by a physician
• The patient is homebound* because of illness or injury
• The patient needs intermittent (part-time) nursing care, physical therapy, occupational therapy or speech therapy. Medical social services and home health aide services are covered only if the patient is receiving nursing care or physical or speech therapy.
• The plan of care is appropriate for the cure and treatment of the injury/illness.

Homebound* - back to top

• Physician Certifies Homebound Status
• Normal inability to leave home without a considerable and taxing effort
• Patient with psychiatric condition, if illness manifests itself in patient’s
refusal and/or patient is considered unsafe to leave home unattended
• Need for supportive devices in conjunction with physical limitations
considered
• Not affected by frequent absences from home for medical care that cannot be provided in home
• Homebound patient is allowed brief and infrequent absences from home for non-medical reasons
• Homebound status not met when:
• frequent absences from home are for social reasons
• if patient is able to drive a car
• Note: The patient’s inability to drive or the lack of transportation does not make a patient homebound