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HH Eligibility
Petria,
On Wednesday’s class, you kept stating the HH is included under Medicare Part A. As far as I have known, HH is a Medicare Part B benefit unless the patient has been inpatient at a hospital for at least 3 days or been in a SNF then goes on HH within 14 days then Medicare A will cover but only for the first 100 days. I have told my agencies that if a patient does not have Medicare B, they are not eligible for HH services unless they have been inpatient as stated above and make sure they d/c after 100 days. I am hoping you can clarify..
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10 Replies
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Hi Tiffany, no that is not correct. Every since home health started it has been a Part A benefit. It used to be that if they did not have Part A they could not receive home health. That did change over 10 years ago and beneficiaries who did not qualify under the Part A benefit but has Part B only can opt to obtain home health benefits under Part B.
A home health client does not and has never had to have a prior hospitalization to be eligible for home health as long as I’ve been in the industry. The rules you are stating sound sort of like the requirement for skilled nursing facilities NOT home health.
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Let me add, that is why we have community and institutional now. To signify where the patient came from, a community referral (straight from the doctor or ???) or an institutional referral (from the inpatient facility within the last 14 days prior to admission to home health) Patients have always been able to come from the community. Now starting in 2020 the agency will get paid more if the patient is an institutional referral.
I hope this helps.
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When I call Medicare today about this question this is what they told me
HH Medicare Eligibility
Home Health care can be covered under either Medicare Part A or Part B.
Under Part B, a patient is eligible for home health care if they are homebound and
need skilled care. There is no prior hospital stay requirement for Part B coverage of
home health care. There is also no deductible or coinsurance for Part B-covered home
health care.
While home health care is normally covered by Part B, Part A provides coverage in
certain circumstances after a patient is in a hospital or SNF. Specifically, if a patient
spends at least three consecutive days as a hospital inpatient or has a Medicare-covered
SNF stay, Part A covers the first 100 days of home health care. The patient still must
meet other home health care eligibility requirements, such as being homebound and
needing skilled care. The patient also must receive home health services within 14 days
of the hospital or SNF discharge to be covered under Part A. Any additional days past
100 are covered by Part B. Regardless of whether the care is covered by Part A or Part B,
Medicare pays the full cost.
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when talking to the person at medicare they also referenced this website
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Hi Tiffany, I’m really surprised that someone with the MAC would lead you outside of Medicare to reference a guideline such as this. They normally don’t do that and I’ve never seen them do that before. This site is not a Medicare website. This information is not correct. I would stick with http://www.medicare.gov as a reference, as they ARE Medicare.
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Hi Stephenie, you called your MAC (which one and did you get a reference # or the name of the person you spoke to?) and they gave you this information? Did you copy and paste this from somewhere? Home Health is not based on the number of days or the information that you are referencing. When it first started back in 1965 it was based on some of that criteria, however, a beneficiary may have Part A only and come from a doctor, not a hospital stay, and receive home health benefits and stay on service for as long as they need to. As long as it is medically necessary and homebound, of course.
I do not agree as this is not what I have experienced in my 31 years.
I will still pass this by a consultant or two to see what their take is on this, too.
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- Thanks Petria. We are going to call again and find out what the deal is. This has been my understanding since I started on the HH side last year so was confused by Wednesday’s class info. In fact, we had a claim deny for the patient having Med A only because the inpatient claim had not processed yet. When we resent the claim after the inpt. Claim processed, we were paid. Stephenie called 1800MEDICARE and was given that reference.
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Ok, I think we got it figured out. We called NGS, CGS, and Palmetto. This is the consensus and info based on the Medicare Benefits Manual Chapter 7, Section 60.
Home Health care can be covered under either Medicare Part A or Part B.
Under Part B, a patient is eligible for home health care if they are homebound and need skilled care. There is no prior hospital stay requirement for Part B coverage of home health care. There is also no deductible or coinsurance for Part B-covered home health care.
While home health care is normally covered by Part B, if a patient has Part A and Part B, then Part A provides coverage in certain circumstances after a patient is in a hospital or SNF. Specifically, if a patient spends at least three consecutive days as a hospital inpatient or has a Medicare-covered SNF stay, Part A covers the first 100 days of home health care. The patient still must meet other home health care eligibility requirements, such as being homebound and needing skilled care. The patient also must receive home health services within 14 days of the hospital or SNF discharge to be covered under Part A. Any additional days past 100 are covered by Part B.
If the patient has Part A only, the inpatient and 100-day rule doesn’t apply and all services are covered under Part A.
Regardless of whether the care is covered by Part A or Part B, Medicare pays the full cost.
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Thanks so much for that clarification in today’s video! We were so confused because the rep at 1800MEDICARE is the one who referenced the medicare interactive.org site! When we spoke to our 3 separate MACs, we were given references directly to the Medicare Benefits Manual that helped us understand clearly. And we received an explanation on that claim I referenced; we were originally told it was because the patient had Med A only but it was because the entitlement date had not been updated at the time the claim was submitted. You are totally right about getting different answers from different people when you call in!
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Awesome! I just love light bulb moments! Remember everyone, there is NO DUMB QUESTION. You all have come here to learn and I love teaching and guiding and if needed helping you to find out. Happy Learning!
Tiffany I love how you research and research and research! You are exemplifying a character trait of a great biller/collector. This is what we do, problem solve! Keep up the good work!
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