What Documentation Is Required for Medicare Home Health Care Coverage?

The documentation required for Medicare home health care coverage includes a doctor's certification of your need for care, ranging from skilled nursing care to physical, speech or occupational therapies. This certification establishes a medical necessity for home health care, ensuring your coverage extends to those services.

Medicare Part A and/or Part B cover home health care services, so long as you meet certain conditions. You must display a medical need for part-time skilled nursing care and be homebound. This means that you're unable to leave home or that doing so requires considerable effort or the help of an aid. A Medicare-certified home health agency must provide the needed services to qualify for coverage.

Home health care services that Medicare covers vary based on an individual's specific needs, though they typically include:

• Intermittent skilled nursing
• Home health aides
• Hospice care
• Physical, speech or occupational therapy
• Medical social services
• Preventative services
• Durable medical equipment
• Mental health services
• Some outpatient drugs

For Medicare to cover home health care, you must provide certification documenting a face-to-face encounter with your doctor or other health care professional, such as a nurse practitioner. This may occur in the form of a clinical note or discharge summary. 

Your doctor must also provide a comprehensive plan of care detailing your condition and health needs. 
It should include your diagnosis and the types of services required, along with the frequency and duration of these services and the expected outcomes. Additionally, your doctor must verify that you are homebound and require the support of skilled services. For the continuation of benefits, Medicare requires ongoing documentation to support the continued need for home health services.

When it comes to securing Medicare benefits, initial certifications for home health care must occur no more than 90 days before or 30 days after the start of the prescribed services. In addition to having a documented care plan established by a doctor, Medicare also requires regular reviews of your plan and updates on any changes in your condition. This is necessary at least every 60 days.

Recipients of home health care benefits must contract the services of a Medicare-certified home health care agency. Even so, limitations exist. Medicare does not cover nonmedical in-home services, such as personal care, meal deliveries and assistance with activities of daily living. However, coverage may extend to these services if skilled care is also required. For further help in understanding the intricacies of Medicare, reach out to your local Aging and Disability Resource Center to speak with a trained benefits specialist.