Understanding the Medicare Benefit - Bronson Healthcare

Understanding the Medicare Benefit

Medicare will pay for 100 percent of what is commonly called “Medicare Home Health Services" if the individual or patient requiring services meets certain criteria including:

  • The patient is a Medicare eligible beneficiary
  • The patient is receiving care from a home health agency, such as Bronson at Home, that has a valid agreement to participate in the Medicare program.
  • The patient is homebound or confined to his or her residence, meaning it takes a taxing effort to leave the home.
  • The patient is under the care of a physician and receiving services under a plan of care that is established and periodically reviewed by a physician.
  • The patient is in need of skilled nursing care on an intermittent basis, or in need of physical therapy, speech/language therapy or has a continuing need for occupational therapy.

What are the “home health” services covered by Medicare?

  • Nursing, under the supervision of a registered professional nurse
  • Physical therapy, occupational therapy, or speech-language pathology services
  • Home health aide services
  • Routine and non-routine medical supplies
  • Medical social services

What are some examples of skilled care?

  • Intramuscular or intravenous injections
  • Observation and evaluation of a patient if the probability exists that significant changes will occur which require the intervention of a physician or nurse
  • Extensive, complex decubitus (bed sores) or wound care
  • Teaching of complex self-care and patient management of the disease process
  • Therapy services following orthopedic surgery

What is NOT covered under the Medicare benefit?

  • Transportation
  • Housekeeping
  • Meals on wheels
  • Drugs and biologicals
  • Inhalation therapy
  • Nutritional counseling
  • Hourly care
  • Custodial care
  • Medication set-ups

 

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