Physiotherapy, occupational therapy and speech and language pathology. For all covered home health care services, you don't pay anything. Before providing you with any service or supply that Medicare doesn't cover, the home health care agency must send you an advance notice of lack of coverage for the beneficiary (ABN), including the items or services that Medicare may not pay for, an estimated cost of those items and services, and the reasons why Medicare might not pay for them. Under Medicare Part B, you are eligible for home health care if you are homebound and need specialized care even if you haven't been hospitalized before.
This comprehensive guide will discuss everything you need to know about Medicare home health coverage and its implications for physical therapy practices. Medicare Part B covers part of the cost of medically necessary wheelchairs, walkers, and other home medical equipment (Medicare will not cover electric wheelchairs that are only needed for use outside the home). If you receive your Medicare benefits through a Medicare Advantage (Part C) plan or another Medicare health plan, check with your plan for more information about your home health benefits. It can also help pay for assisted living centers, which offer older people the ability to live independently, albeit with help. Medicare will pay for what are considered intermittent nursing services, meaning care is provided less than seven days a week or daily for less than eight hours a day, for up to 21 days.
Based on this demonstration, your home health agency can submit to Medicare a request for a pre-claim review of coverage for home health services. However, you may be responsible for 20% of the amount approved by Medicare for durable medical equipment and the standard deductible for Part B applies. When you are done with your other home health care needs, you can continue to receive occupational therapy covered by Medicare under the home health benefit, if you need it. Your Medicare home health care benefits will not change, and your access to home health care services should not be delayed due to the pre-application review process.
The maximum amount of weekly care that Medicare will pay for is usually 28 hours, although in some circumstances it can cover up to 35 hours. Unlike Medicare, Medicaid covers long-term care in custody, including nursing home care and home and community-based services (HCBS).
