Medicare Eligibility, Certification, and Face-to-Face Encounter
For a Medicare-certified agency, sets out how the Agency confirms a patient meets the Medicare home health eligibility criteria, verifies homebound status, makes sure the physician or allowed practitioner certifies and recertifies eligibility with the required content and timing, and makes sure the face-to-face encounter happened in time and is documented.
About this policy
- Policy number
- TX-HH-ADM-03
- Version
- 1.0
- Main rule
- 42 CFR §424.22
- Library
- Texas home health · 56 policies
- Category
- Service delivery
- Sections
- 19
In short
- For Medicare patients, verify and document eligibility and homebound status at both the initial assessment visit and the comprehensive assessment.
- Write homebound documentation with facts: what the patient needs to leave home and why leaving is a considerable and taxing effort.
- The face-to-face encounter must be within 90 days before or 30 days after the start of care, related to the main reason for home health, and its date documented by the certifying practitioner.
- Recertification is needed at least every 60 days while care continues.
- Do not bill until the plan of care, certification, and verbal orders are signed and dated.
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 the nurse verified homebound status at the initial and comprehensive assessments for this patient.
- Who performed the face-to-face encounter for this patient, on what date, and where is it documented?
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