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Homebound status Medicare vs. Insurance

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Aredhel13 Aredhel13 (New) New

Wondering if anyone else has run into this situation. Our agency census is about 70% insurance patients and 30% Medicare. Not all the insurance patients are Medicare HMO. The insurance companies/IPA's often have home health see a patient who is not strictly "homebound" according to the guidelines, but is better for them and they authorize payments becouse their philosophy is a little different than Medicare. During our last state survey one of the findings was that we were accepting patients who were not homebound, with the rationale being that if we accept any Medicare patients all our patients have to be "homebound" even if Medicare is not paying (this was a younger man on private insurance).

Has anyone run into this? If so, let me know. Thanks.

Wondering if anyone else has run into this situation. Our agency census is about 70% insurance patients and 30% Medicare. Not all the insurance patients are Medicare HMO. The insurance companies/IPA's often have home health see a patient who is not strictly "homebound" according to the guidelines, but is better for them and they authorize payments becouse their philosophy is a little different than Medicare. During our last state survey one of the findings was that we were accepting patients who were not homebound, with the rationale being that if we accept any Medicare patients all our patients have to be "homebound" even if Medicare is not paying (this was a younger man on private insurance).

Has anyone run into this? If so, let me know. Thanks.

i have only found that medicare patients need to follow the homebound criteria,,,private insurances are different, some require it some don't, medicare HMO follow the medicare guidelines. never heard of the situation you are describing....me being me would have to see that in the state policy.

HHheart

Specializes in Home Health, Med-Surg, Ortho. Has 15 years experience.

That makes no sense at all. Each commercial insurance company has differing criteria. I'll bet he was a fairly new surveyor - sometimes you have to remind them that commercial insurance is a different animal.

I would think that it would be common sense that Medicare rules apply to Medicare patients and the rules of each insurance company applies to the clients of that company. If there were standardized federal or state rules then each entity would be using the same rulebook. It certainly would simplify things if everyone used the same rules.:confused:

jnette, ASN, EMT-I

Specializes in Hemodialysis, Home Health. Has 10 years experience.

Only medicare patients have the homebound requirement...(unless specifically noted otherwise by the patient's private insurance company, and it would be rare). Most of our patients (90%) are MCR, we have only very few private insurance pts.

I agree with the above poster.. this surveyor must have been new on the job, and needs to do his/her homework.

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