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MemberJune 19, 2020 at 1:02 pm
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.