{"ref":"GA-HH-ADM-03","title":"Medicare Eligibility, Certification, Face-to-Face Encounter, and Homebound Status","category":"Service delivery","summary":"Explains how the Agency confirms, for each Medicare patient, that the patient is eligible for the Medicare home health benefit, including homebound status and the need for skilled services; obtains a signed certification and recertification from a qualified physician or allowed practitioner; documents the face-to-face encounter; and makes sure the record supports eligibility before any claim is made.","inShort":["Medicare pays for home health only if the patient is homebound, needs skilled care, and a doctor or allowed practitioner certifies it.","At the first visit and the full assessment, write down the facts that show the patient is homebound: what makes leaving home hard and what help they need.","The face-to-face visit must be within 90 days before or 30 days after the start of care, and its date must be on the certification.","Tell the supervising nurse if a patient seems no longer homebound or no longer needs skilled care."],"primaryCitation":"42 CFR §424.22","citations":["Ga. Comp. R. & Regs. 111-8-31-.09","Ga. Comp. R. & Regs. 111-8-31-.09(b)"],"federalCitations":["42 CFR §424.22","42 CFR §424.22(d)","42 CFR §409.42","42 CFR §409.43","42 CFR §484.55","42 U.S.C. §1395f(a)"],"surveyorAsks":["Show me how you verified homebound status for this Medicare patient at the initial and comprehensive assessments.","When did the face-to-face encounter take place, who performed it, and where is the date documented?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §424.22)","5. Eligibility Screening at Intake","6. Verifying Eligibility and Homebound Status at Assessment","7. The Certification","8. The Face-to-Face Encounter","9. Supporting Documentation","10. Recertification","11. Signatures Before Billing","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"ga-hha","state":"Georgia","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}