Patient Coverage/Qualifiers

Medicare Part A/B covers certain types of Intermittent Skilled Homecare services discussed in detail below. Medicare does not cover Private Duty/Custodial/Homemaker or Personal Care services as the sole service being provided in the home. If Skilled Care services are being provided in the home setting, based on a qualifying diagnosis by a Licensed Physician, limited Personal Care services (i.e. Bathing, Dressing, Make Bed, etc.) can be provided for a short time until recovery occurs enabling patient to complete the task(s) on their own.

Your costs in Original Medicare
  • You pay 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare-covered medical equipment.

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services if you meet all of these conditions:

  • You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need, one or more of these:
    1. Intermittent skilled nursing care (other than drawing blood)
    2. Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe, and an effective treatment for your condition. The amount, frequency, and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively.
    3. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
    4. You must be homebound, and a doctor must certify that you’re homebound.
  • You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.
  • Home health services may also include medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.

Eligible home health services include:

  • Part-time or intermittent skilled nursing care
  • Part-time or intermittent home health aide care
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services

Medicare doesn’t pay for:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Custodial or personal care (help bathing, dressing, and using the bathroom) when this is the only care you need
  • Homemaker services

Post-Acute Provider E-Referral Systems

Below is a list of Electronic Referral Systems accepted by Acclaim Home Care Services which can be utilized to transmit P.H.I. (Protected Health Information) regarding electronic referral requests.