|  | Healthcare Industry | Medicare

Medicare Home Health Care PPS: Frequently Asked Questions

Many elderly patients who are covered by Medicare will require home health services at some point. Home health agencies play an important part in meeting the needs of these patients. In July of 2000, the policies that oversee this part of Medicare were amended to create cost control of the services that were being paid for by Medicare to home health agencies through the Prospective Payment System. As a result there have been common questions generated about the payment process.

  1. How Are Payments Made?

    • Home health agencies receive payment on a 60-day basis of care. The first half of an estimated base payment will be provided to the home health agency upon receipt of the initial claim. The payment is based on the patient's condition and what care is provided. If the cost of caring for the patient increases above the estimated base, pay adjustments can be made to the second half of the payment, which is provided to the home health agency at the end of the 60 days of care.

    What If Longer Care Is Needed?

    • A patient who has reached the end of her initial 60 days of care will be assessed to see whether continuing care is still needed. Upon determination of the need of continued care a new claim will need to be filed on the patient's behalf. This will allow a new 60-day period of care to begin, which will be paid for in the same manner as the first 60-day period.

    Why Are Payments Adjusted?

    • The payments that are made for a patient in the 60-day care period may be adjusted based on the needs of the patient. Home health agencies will not be expected to fund the expenses of the most costly patients with more expensive care requirements. Nor will Medicare pay more than what is needed for a patient who needs only a few visits from the home health agency during the 60 days of care. Medicare reserves the right to adjust the base payment of each patient as needed so that the patient's needs are met and to prevent the home health agency from being overpaid.

    Changing Home Health Agencies

    • A partial payment is put in place if a patient chooses to change home health agencies prior to the expiration of the 60-day term of care. When the patient is enrolled in the new home health program, the 60-day term of care will be reinstated and a partial payment will be provided to the new agency to cover the remaining portion of care. The previous home health agency will not be able to claim any of the remaining payment after the patient has left the program.

Medicare - Related Articles