In 2023, people 65 and older made up 17.3% of the U.S. population, a number which is growing. As the population ages, more people rely on in-home healthcare to manage chronic diseases and other age-related conditions. With most of this population relying on Medicare, it is important to understand whether or not these services are covered.
In-home care helps seniors and others with chronic illnesses maintain a sense of independence and it frees up space in assisted living facilities. Most seniors want to age in place, and these services make it easier. Many of them want to know the extent of Medicare coverage for home care.
Medicare’s home health benefits aren’t comprehensive and your patients have to meet certain criteria. To get reimbursed for these services, you need proper documentation.
WorldView’s home health solutions help you manage electronic health records, referrals, and other documentation required by Medicare.
What Types of Home Care Does Medicare Cover?
Medicare Part A and Medicare Part B each cover home health services as long as you need them and are homebound. To qualify, your patient needs to have trouble leaving the house without help because of an injury or illness. They could also be unable to leave their home.
If you’re offering medically necessary skilled nursing services, your patients would qualify for Medicare coverage. Some of these include:
- Wound care for surgical wounds and pressure sores
- Intravenous nutrition
- Injections
- Health monitoring
- Patient and family education
- Physical therapy
- Occupational therapy
- Speech language pathology
Who Qualifies for Medicare Home Care?
To be eligible for reimbursement, your patients need to see a doctor in person who certifies that they need home health services. These patient referrals are critical for Medicare home health benefits. WorldView solutions — such as MedAttach — can help you track these referrals quickly, and submit them with claims.
Physician orders are essential for your patients looking to use Medicare to cover their care. A doctor must order your services and your agency has to be certified by Medicare as a provider. Tracking these orders makes the intake process seamless.
You can utilize WorldView’s Physician Order Tracking to manage physician orders and prepare for your daily caseload. Our solution automates physician orders without you having to fill out physical paperwork and fax it. You can get a physician to sign off on your orders more quickly to improve patient care.
Common Misconceptions About Medicare and Homecare
Home health eligibility is limited to medically necessary skilled nursing care at home. It doesn’t cover personal care, home cleaning, or meal delivery. Your patients are not eligible for 24/7 home care services. Medicare is limited to part-time or intermittent services. If your patient needs care for more than 7 days a week or daily for more than 8 hours up to 21 days, Medicare won’t cover your services.
Although Medicare Part B covers transportation for some patients, they need to meet strict criteria. Your patients may need a supplemental insurance plan or they could pay out of pocket for long-term home care, nursing home services, and non-medical home care.
Documentation and Compliance: Meeting Medicare’s Standards for Home Care
Medicare requires extensive documentation for compliance before it will pay you for providing in-home medical care services. You need to verify a face-to-face encounter with their physician dated between 90 days before or 30 days after the service. The doctor’s paperwork should include documentation that shows the patient meets homebound criteria.
If you have these documents, you may need additional documentation to support the initial physician’s assessment. You also need a physician order for each visit as well as a detailed care plan outlining the patient’s condition and what you’re doing to manage it.
WorldView’s MedAttach offers a solution to easily capture and upload documents. This tool routes documents automatically based on specific rules and sends email notifications. Your administrators can quickly match physician orders to existing patient records and you'll know you have all relevant information for each patient before submitting claims to Medicare.
How WorldView Supports Medicare-Compliant Home Care
Medicare does pay for in-home healthcare. But to be eligible, your patients need to meet certain criteria. To prove it, you need to consolidate healthcare referrals, physician orders, and electronic documents. WorldView’s home healthcare AI solutions including Mobile Complete, Physician Order Tracking, and Referral AI offer everything you need to keep track of your paperwork without spending a lot of time on administrative work.
Referral AI can process your referrals in minutes, freeing you up to spend more time assessing patients during intake and managing care plans.
Conclusion: Navigating Medicare Home Care With Confidence
Does Medicare pay for in-home care? Medicare does cover in-home healthcare for skilled medical services. It’s important to work with a home health agency that understands various rules and regulations for compliance. If you’re not familiar with these regulations, you risk providing services that aren’t eligible for payment and having Medicare deny your claims.
Medicare-approved agencies across the country use WorldView’s solutions to manage their workloads and stay compliant with documentation requirements. Schedule a demo to see how we can help you deliver Medicare-compliant home care more effectively.
