What are home health care and the types of services they provide?

The range of home health care services a patient can receive at home is limitless. Depending on the individual patient's situation, care can range from nursing care to specialized medical services, such as laboratory workups. You and your doctor will determine your care plan and services you may need at home. At-home care services may include:

Doctor care. A doctor may visit a patient at home to diagnose and treat the illness(es). He or she may also periodically review the home health care needs.

Nursing care. The most common form of home health care is some type of nursing care depending on the person's needs. In consultation with the doctor, a registered nurse will set up a plan of care. Nursing care may include wound dressing, ostomy care, intravenous therapy, administering medication, monitoring the general health of the patient, pain control, and other health support.

Physical, occupational, and/or speech therapy. Some patients may need help relearning how to perform daily duties or improve their speech after an illness or injury. A physical therapist can put together a plan of care to help a patient regain or strengthen the use of muscles and joints. An occupational therapist can help a patient with physical, developmental, social, or emotional disabilities relearn how to perform such daily functions as eating, bathing, dressing, and more. A speech therapist can help a patient with impaired speech regain the ability to communicate clearly.

Medical social services. Medical social workers provide various services to the patient, including counseling and locating community resources to help the patient in his or her recovery. Some social workers are also the patient's case manager--if the patient's medical condition is very complex and requires the coordination of many services.

Care from home health aides. Home health aides can help the patient with his or her basic personal needs such as getting out of bed, walking, bathing, and dressing. Some aides have received specialized training to assist with more specialized care under the supervision of a nurse.

Homemaker or basic assistance care. While a patient is being medically cared for in the home, a homemaker or person who helps with chores or tasks can maintain the household with meal preparation, laundry, grocery shopping, and other housekeeping items.

Companionship. Some patients who are home alone may require a companion to provide comfort and supervision. Some companions may also perform household duties.

Volunteer care. Volunteers from community organizations can provide basic comfort to the patient through companionship, helping with personal care, providing transportation, emotional support, and/or helping with paperwork.

Nutritional support. Dietitians can come to a patient's home to provide dietary assessments and guidance to support the treatment plan.

Laboratory and X-ray imaging

Certain laboratory tests, such as blood and urine tests, can be performed in the comfort of the patient's home. Also, portable X-ray machines allow lab technicians to perform this service at home.

Pharmaceutical services. Medicine and medical equipment can be delivered at home. If the patient needs it, training can be provided on how to take medicines or use the equipment, including intravenous therapy.

Transportation. Some companies provide transportation to patients who require transportation to and from a medical facility for treatment or physical exams.

Home-delivered meals. Often called Meals-on-Wheels, many communities offer this service to patients at home who are unable to cook for themselves. Depending on the person's needs, hot meals can be delivered several times a week.

Describe the reimbursement process for home health agencies by Medicare.

Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary. The payment is also adjusted for the geographic differences in wages for HHAs across the country. The adjustment for the health condition, or clinical characteristics, and service needs of the beneficiary is referred to as the case-mix adjustment. The home health PPS will provide HHAs with payments for each 60-day episode of care for each beneficiary. If a beneficiary is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a beneficiary who remains eligible for the home health benefit can receive. While payment for each episode is adjusted to reflect the beneficiary's health condition and needs, a special outlier provision exists to ensure appropriate payment for those beneficiaries that have the most expensive care needs. Adjusting payment to reflect the HHA's cost in caring for each beneficiary including the sickest, should ensure that all beneficiaries have access to home health services for which they are eligible.

What is the purpose of the Medicare Home Health Face-to-Face requirement?

The Medicare Face-to-Face Home Health requirement, a regulation by the Affordable Care Act, requires an in-person physician's visit to certify a patient's home health benefit, according to cms.gov. This means that under the law, a physician must assess and document a patient's condition and provide a brief narrative verifying their eligibility for the home health Medicare benefit. While revisions to this requirement were later made, some important initial provisions of this requirement are as follows:

A physician or allowed non-physician practitioner (NPP) must document having met with a patient face-to-face and certify them for Medicare home health benefits

The certification for service eligibility must be related to the physician's assessment of a patient's clinical condition

Patients beginning care on or after January 1, 2011, require this documentation on their certification

The visit must occur within 90 days before, or within 30 days after the beginning of home health care

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Under the law, insurance companies and group health plans will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This summary of benefits and coverage document will help consumers better understand the coverage they have and, for the first time, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. People will receive the summary when shopping for coverage, enrolling in coverage, at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health .

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Home Health Care Services

 1. Types of Services Provided:

 Doctor Care: Doctors visits to the homes of the patients for disease diagnosis, management and regular follow ups.

 Nursing Care: Services comprise of wounds, ostomy, intravenous, hydromorphone and other drug administration and observation of health changes and alleviation of pain.

 Therapies:

 Physical Therapy: Muscle and joint relief.

 Occupational Therapy: Provides care to the patients who have physical or mental challenges in their ability to execute their daily activities.

 Speech Therapy: Helps in enhancement of skills of communicating.

 Medical Social Services: Offers psychotherapy plus service coordination/coordination/ brokerage for mental health problems that are severe and/or chronic.

 Home Health Aides: Helps in washing and dressing of patients or clients.

 Homemaker Services: This encompasses taking care of the meal, doing the laundry and any other housely chores.

 Companionship: Provides security to the patient who stays at home alone since they can be monitored by the nurses.

 Volunteer Care: Offers necessities such as food, shelter, clothing and some sort of companionship among other things.

 Nutritional Support: The assessments of the diets taken and the advice given by the dietitians.

 Laboratory and Imaging: A home based laboratory testing and portable X-ray services.

 Pharmaceutical Services: Delivery of medicines and equipment, with staff training if required.

 Transportation: It provides transportation to and from medical centres.

 Home-Delivered Meals: Other disservices include home delivered meals for those patients who cannot prepare their meals.

 How Medicare reimburses Home Health Agencies

 Medicare reimburses Home Health Agencies (HHAs) under a prospective payment system:Medicare reimburses Home Health Agencies (HHAs) under a prospective payment system:

 Base Payment: A flat fee paid for each 60 day episode of care.

 Case-Mix Adjustment: Changes that would depend on the current state of the patient as well as the kind of care he/she requires.

 Geographic Adjustment: It also true reflect regional wage differences of many countries.

 Outlier Provision: Makes correct billing for patients with cost-intensive requirements.

 Episodes: There is no limit on the number of episodes within a treatment centre; further episodes are included as long as the patient still qualifies for the service.

 In Medicare Home Health Face-to-Face Requirement

 Purpose: To make sure that a physician or non-physician practitioner allowed by Medicare certifies a beneficiary for home health care:

 In-Person Visit: Documentation of a face-to-face visit with a patient is required to be done by a physician or a NPP.

 Certification Documentation: It is also obligatory to connect those parameters with the clinical condition assessed.

 Timing: Home health care condition for visit to occur is that patient Start home health care withing 90 days before or 30 days after a visit.

 Applicability: For patients new to the care of CPI and who commence care on or after January 1, 2011.

 Issues and Solutions

 Issues:

 Complexity of Reimbursement Process: Being able to make correct and timely adjustments for a patient’s care plan can be difficult.

 Compliance with Face-to-Face Requirement: Adhering to document writing and timing standards can sometimes be a challenge.

 Coverage Limitations: Patients can be rationed access in proportion to their own requirements and in consideration to geographic location.

 Potential Solutions:

 Streamlined Documentation: Install electronic health records (EHR) systems for effective documentation to enhance self reporting.

 Training and Resources: Ensure the care managers have received adequate training in the aspects of the special needs of Medicare and EHR systems.

 Policy Review: Some of the tips they suggest include: The policies should be reviewed and updated to reflect the new needs and also enhance efficient reimbursement.

 Thoughts on Face-to-Face Requirement:

 The face-to-face requirement is envisaged to prevent circumstances that would lead to giving people health care services they do not need at their homes. On the one hand it provides for better control and regulation, on the other hand it can, at times, present logistical problems. The mixture and high quality documentation with the practical application of means and methods is the key to maintaining the high level of care while avoiding excessive paperwork