Medicare Eligibility, Certification, Face-to-Face Encounter, and Homebound Status
For a Medicare-certified Agency, sets out how the Agency confirms that each Medicare patient meets the conditions for Medicare home health coverage (confined to the home, under the care of a physician or allowed practitioner, in need of intermittent skilled nursing, physical therapy or speech-language pathology, under a plan of care), obtains a complete certification signed by the certifying physician or allowed practitioner including the face-to-face encounter, documents homebound status at each visit, and obtains recertification at least every 60 days when care continues. For other payers, the Agency meets the payer's own criteria, as LAC 48:I §9123.A.4 requires.
- Policy number
- LA-HH-ADM-03
- Version
- 1.0
- Main rule
- 42 CFR §424.22
- Library
- Louisiana home health · 57 policies
- Category
- Service delivery
- Sections
- 18
In short
- Medicare home health needs a homebound patient, a skilled need, a plan of care and a signed certification.
- Write specific facts about why leaving home is a taxing effort; the word "homebound" alone is not enough.
- The face-to-face encounter must be within 90 days before or 30 days after the start of care.
- Recertification is needed at least every 60 days while care continues.
- Tell the clinical manager the same day if a patient seems no longer homebound.
What's inside
18 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. Medicare Coverage Conditions (42 CFR §409.42)
- 6. Homebound Status
- 7. Certification and the Face-to-Face Encounter (42 CFR §424.22(a))
- 8. Recertification (42 CFR §424.22(b))
- 9. Who May Certify; Supporting Documentation
- 10. Patients of Other Payers
- 11. Responsibilities
- 12. Records and Compliance Monitoring
- 13. Staff Training
- 14. References
- 15. Related Policies and Forms
- 16. Approval
- 17. Revision History
An inspector may ask
- How do you verify that this Medicare patient is homebound? Show me the documentation at the initial and comprehensive assessments and in recent visit notes.
- Where is the face-to-face encounter documented, and who performed it? Was it within the required window?
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