Medicare Eligibility, Certification, Face-to-Face Encounter, and Homebound Status
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.
About this policy
- Policy number
- GA-HH-ADM-03
- Version
- 1.0
- Main rule
- 42 CFR §424.22
- Library
- Georgia home health · 56 policies
- Category
- Service delivery
- Sections
- 19
In short
- 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.
What's inside
19 sections. The full text comes with the One-time Policy Pack.
- 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
An inspector may ask
- 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?
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