Home Health PPS (Test 3)
HHAs provide skilled care to people who are... - answer typically homebound
-may be free standing or based in hospitals/other healthcare organizations
-HHAs must be licensed per state or local law
-must meet Medicare Conditions of Participation (CoP)
-covered under Medicare Part A & B
HHA - answer home health agency
Home health services may be rendered: - answer-part time or intermittent
Includes:
-PT, OT, SLP (Speech Language Pathology)
-SN (Skilled Nursing)
-Durable Medical Equipment
-Routine medical supplies
etc.
To be eligible for Medicare home health services, a physician must certify that a pt: -
answer-Is confined to the home
-Needs skilled services (intermittent skilled nursing, PT, etc.)
-Is under the care of a physician
-Receives services under a plan of care established and reviewed by a physician
-Had a face-to-face encounter with a physician or allowed non-physician practitioner
"Confined to the home" definition - answerDefined by CMS:
An individual shall be considered 'confined to the home' (homebound) if the following
two criteria are met:
-The pt must need 1 of the following......
--the aid of supportive devices (ex. cane, wheelchair)
--the use of special transportation
--the assistance of another person in order to leave home
--or the pt has a condition that makes leaving their home medically contraindicated
-The pt must also.....
--have a normal inability to leave home AND leaving home must require a considerable
and taxing effort
, Confined to the home continued... - answer-An old person who doesn't leave the house
because of frailty and insecure doesn't count as "homebound" unless they meet the
specified conditions
-Absences from the home are excused for the following scenarios:
--Infrequent
--Short duration
--Health care treatments
--Going to church (Grandma's gotta have Jesus)
--To attend adult daycare programs
--For other events (ex. funeral, graduation, barber)
Medicare home health continued:
Face to face encounter definition - answer-a face-to-face encounter occurred:
-w/in 90 days prior to the start of home health care
-or w/in 30 days after the start of care
Under both Part A & B Medicare, home health services must be certified by a: - answer-
Home health physician
-Nonphysician practitioner working in collaboration w/ the certifying physician
-Physician caring for the pt during an acute or post acute hospitalization prior to home
health services
Certification must be obtained: - answer-When the plan of care is established or as
soon thereafter as possible
-Recertify the services at least once every 60 days (w/in 5 days of the end of current
episodes, days 56-60)
--Continuing need exists for the services
--Estimation of how long services will be needed
--The plan of care must also be reviewed and updated every 60 days
HHPPS - answerhome health prospective payment system
Went into effect Oct 1, 2000
The unit of payment is the episode of care (*not* per diem)
No cost sharing for home health services (except 20% for DME)
Episode of care payment... - answer-consolidated payment of all home health services
during a 30-day period, usually more than one date of service
-The case-mix adjustment under HHPPS included:
--Clinical, Functional & Service dimensions
HHAs provide skilled care to people who are... - answer typically homebound
-may be free standing or based in hospitals/other healthcare organizations
-HHAs must be licensed per state or local law
-must meet Medicare Conditions of Participation (CoP)
-covered under Medicare Part A & B
HHA - answer home health agency
Home health services may be rendered: - answer-part time or intermittent
Includes:
-PT, OT, SLP (Speech Language Pathology)
-SN (Skilled Nursing)
-Durable Medical Equipment
-Routine medical supplies
etc.
To be eligible for Medicare home health services, a physician must certify that a pt: -
answer-Is confined to the home
-Needs skilled services (intermittent skilled nursing, PT, etc.)
-Is under the care of a physician
-Receives services under a plan of care established and reviewed by a physician
-Had a face-to-face encounter with a physician or allowed non-physician practitioner
"Confined to the home" definition - answerDefined by CMS:
An individual shall be considered 'confined to the home' (homebound) if the following
two criteria are met:
-The pt must need 1 of the following......
--the aid of supportive devices (ex. cane, wheelchair)
--the use of special transportation
--the assistance of another person in order to leave home
--or the pt has a condition that makes leaving their home medically contraindicated
-The pt must also.....
--have a normal inability to leave home AND leaving home must require a considerable
and taxing effort
, Confined to the home continued... - answer-An old person who doesn't leave the house
because of frailty and insecure doesn't count as "homebound" unless they meet the
specified conditions
-Absences from the home are excused for the following scenarios:
--Infrequent
--Short duration
--Health care treatments
--Going to church (Grandma's gotta have Jesus)
--To attend adult daycare programs
--For other events (ex. funeral, graduation, barber)
Medicare home health continued:
Face to face encounter definition - answer-a face-to-face encounter occurred:
-w/in 90 days prior to the start of home health care
-or w/in 30 days after the start of care
Under both Part A & B Medicare, home health services must be certified by a: - answer-
Home health physician
-Nonphysician practitioner working in collaboration w/ the certifying physician
-Physician caring for the pt during an acute or post acute hospitalization prior to home
health services
Certification must be obtained: - answer-When the plan of care is established or as
soon thereafter as possible
-Recertify the services at least once every 60 days (w/in 5 days of the end of current
episodes, days 56-60)
--Continuing need exists for the services
--Estimation of how long services will be needed
--The plan of care must also be reviewed and updated every 60 days
HHPPS - answerhome health prospective payment system
Went into effect Oct 1, 2000
The unit of payment is the episode of care (*not* per diem)
No cost sharing for home health services (except 20% for DME)
Episode of care payment... - answer-consolidated payment of all home health services
during a 30-day period, usually more than one date of service
-The case-mix adjustment under HHPPS included:
--Clinical, Functional & Service dimensions
