check out cahaba's:
coverage guidelines for home health agencies (aug 06 revision)
94 pages of great advice in easy to read format.
medicare reference guide: home health coverage guidelines updated link 5/15/2008
especially helpful is:
70 conditions the patient must meet (pg. 23)
70.15 documentation of homebound status (pg.26)
70.10 beneficiaries who are not homebound (pg. 25+26)
80.30 prn orders (pg.34)
80.40 verbal/oral orders (pg.35)
90 covered skilled nursing services (pg. 38 -40)
90.5 principle one: requires the skills of a nurse
90.10 principle two: service is not skilled because performed by a nurse
90.15 principle three: service does not become unskilled because it is taught
90.20 principle four: reasonable and necessary
100 skilled nursing services (pg. 40)
100.10 management and evaluation of the care plan(pg. 41)
100.5 observation and assessment (pg. 42)
110 teaching and training activities (pg. 43)
110.5 administration of medications (pg. 44)
110.40 prefilling syringes (pg. 46)
110.70 catheters (pg. 48)
110.75 wound care (pg49)
110.115 diabetes outpatient self-management training (dsmt) (effective 1/1 2004) (pg. 51)
110.120 foot care (pg. 53)
110.130 psychiatric nursing (pg. 54)
140.30 safety dependence/secondary complications (pg. 59)
150 general principles for reasonable and necessary physical, speech, and occupational therapy (pg. 60)
200.5 covered home health aide activities (pg. 71)
210 drugs & biologicals
drugs and biologicals are generally excluded from coverage under the medicare home health benefit. there are a few exceptions from this exclusion.
210.5 drugs covered by medicare part b (pg. 73)
these drugs include hepatitis b vaccine, hemophilia clotting factors, calcitonin, pneumococcal pneumonia vaccine, influenza virus vaccine, and intravenous immune globulin (ivig)
220 coverage exclusions (pg. 76)
240.20 blood glucose monitor (pg. 80)
240.35 protime test systems (pg. 81) * not covered
240.75 covered medical supplies (pg. 82)
240.80 routine medical supplies (pg..83) * not covered
