How do home health agencies get paid?

Scottishtape · Aug 10, 2017

It's usually a bundled payment system.

So, patient has X needs identified and approved for care through their insurance for X number of days (most I've seen are like 90 days, but this varies depending on what the patient needs).

The home health company will receive a set amount for that X amount of time to cover all expenses needed for said care. This can change based on circumstances like the pt has to go to the hospital, or they're re admitted to home care within X number of days from discharge.

Once that specific time frame is almost finished, and the needs of the patient haven't been met, that patient can be re-certified, get another X number of days, and another set payment for the bundled services. If the needs have been met, the patient is discharged.

That's a very basic overview of the pay system of the home health companies I've worked for.

There are a lot of rules and regulations that do affect how much the company will get, but that's going pretty in depth.

caliotter3 · Aug 10, 2017

It sounds as if you are describing an extended care case. The source of the funds is usually stated on the front page of the plan of care (485) in block 21. That rate of pay usually corresponds to one of the government programs as the source, since nurses typically get a few dollars more per hour if the funding source is private insurance or private pay. You would not be out of line to ask the staffing coordinator if this is not clear on the 485.