For all covered Home Care near Stockertown PA services, you don't pay anything. Additional payments will be made to the 30-day period adjusted for combination of cases and associated payments to beneficiaries who incur unusually high costs. These atypical payments will be made during periods of Home Care near Stockertown PA in which the charged cost exceeds a minimum amount for each group of cases. The amount of the atypical payment will be proportional to the amount of the imputed costs that exceed the threshold. Atypical costs will be charged to each period of care by applying the standard amounts per visit to the number of disciplinary visits (specialized nursing visits or physical therapy, speech-language pathology, occupational therapy or home health care services) reported in the claims.
The annual total of national atypical payments for home health services will not exceed 2.5 percent of the estimated total of payments under the PPS for home care. As part of Medicare Part A, you will receive compensation for 100 percent of your home health care costs. If your doctor recommends home care, Medicare will cover the initial evaluation to determine if you're a good candidate. Original Medicare covers eligible home health care services at no cost to you if you meet certain requirements. If you need durable medical equipment (wheelchairs, walkers, crutches, etc.), ask the home health agency which services Medicare will pay for and which won't, as some agencies may recommend services that Medicare doesn't cover.
You'll also pay a co-payment to the hospital for each service you receive on an outpatient basis (except certain preventive services). If you receive your Medicare benefits through a Medicare Advantage (Part C) plan or another Medicare health plan, check with your plan for more information about your home health benefits. After a doctor or licensed professional prescribes a home health care plan, the HHA evaluates the patient's condition and determines the needs for skilled nursing care, therapy, medical social services, and home health care services, at the beginning of the 60-day certification period. For a subsequent hospital stay of at least three days, Medicare Part A covers home health care; otherwise, you pay for Medicare Part B (health insurance).
Home health care is a wide range of health care services that you can receive at home in the event of an illness or injury. Home health care includes a wide range of health and social services provided at home to treat illnesses or injuries. However, you may be responsible for 20% of the amount approved by Medicare for durable medical equipment and the standard Part B deductible applies. To determine eligibility, Medicare defines “intermittent care” as care provided less than seven days a week or every day for less than eight hours a day for up to 21 days. In response, CMS amended Article 409.43 (a) to allow the use of telecommunications technology to be included as part of the home health care plan, provided that the use of such technology does not replace the in-person visit ordered in the plan of attention.
In addition, section 3707 of the CARES Act encouraged the use of telecommunications systems for home health services provided during the public health emergency (PHE) caused by COVID-19. Before you start getting home health care, the home health agency must tell you how much Medicare will pay. You won't qualify for the home health care benefit if you need more than part-time or intermittent specialized care. This means that, in addition to a doctor, these “authorized professionals” can certify, establish and periodically review the plan of care, as well as oversee the provision of items and services to beneficiaries of the Medicare home health (HH) benefit. Even with all of this information, differentiating between home care and home health care can be confusing.
Based on this demonstration, your home health agency can submit to Medicare a request for a pre-claim review of coverage for home health services.
