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Features and Efficacy of Home Care Agencies With Medicare Benefits

Matt Thompson Oct 24, 2019
In this world, where health is the primary concern for people, they are constantly on the lookout for ways to retain, restore and regain their health. However, over the years, people have taken on to some rather unconventional cures.


  • The adoption of severe sepsis protocols in hospitals that invariably saves about 70,000 lives every year.
  • A simple colon cancer screening at home that can prevent about 14,000 deaths annually.
  • The tried and proven steps to prevent medical errors that cause hundreds of thousands of deaths each year.
As a physician, it is natural to be pleased with the positive response from the people but, looking on the flip side, there is a worry that all these methods may not result in a positive action and results.

The Growing Concerns

Therefore, while people can remain interested and focused on their personal health, what they really need to do is understand and avoid several medical problems. However, research says that people are not doing really good in it as it is reflected through the growing medical conditions of diverse types.
It is predicted by the experts in health and home care industry that the psychological nature of the people will demonstrates that people are more predisposed to make choices that will provide them with short-term rewards over long-term gains.
For example, everybody knows that they will gain a lot of health benefits in the long run when they walk about 10,000 steps a day and eliminate sugary sodas from their diets, but it is the short-term rewards that seems to be sweeter which seems to be the primary cause for their inaction.

The Changed Scenario

Most of the people, however, have realized that in order to expand their physical and mental wellbeing and their health and happiness, the powerful solution does not lie in expensive new medication. It turns out to be exercise. Still, health is something that will need constant care and a little deviation from it will result in a system breakdown.
The people have realized this now and have taken on to regular checkups, doctor visits and even investing in a regular home care nurse for achieving optimal health and enjoy its benefits. This has given rise to the number of agencies providing home health care Philadelphia.
  • The home health care industry of today is based on the increase in demand for obtaining such useful care services by the older adults as well as the people with disabilities.
  • Most of the home healthcare agencies of today are Medicare certified to enjoy more benefits, especially when it comes to reimbursements of the payments.
The Medicare-certified home health care agencies are considered to be specialists in providing skilled nursing and therapy services in the home setting. This is an immense help to homebound patients.
  • Have had a hospitalization before and are currently recovering from an injury or acute illnesses and
  • Need constant community-based care management to deal with their existing chronic conditions.
These home health care agencies are unique in its features and attributes as they are the sole Medicare providers that have the special certificate to provide skilled care to the beneficiaries at home. They are authorized to treat all acute, chronic, and rehabilitative conditions.

Functioning of the Home Health Care Agencies

The home health care agencies typically use their interdisciplinary clinical skills and teams that comprise of different health professionals including:
  • Physical therapists
  • Trained nurses
  • Occupational therapists
  • Medical social workers
  • Speech-language pathologists and
  • Expert home health aides

The Medicare Programs

The home care agencies avail traditional Medicare programs that pay in different payment systems depending on the type of the health care provider and the nature of professional services provided.
  • The Medicare programs will pay for acute care hospitals for short-term under their hospital inpatient prospective payment system.
  • It will pay the physicians under their physician fee schedule.
  • It will pay the home health care agencies under their home health prospective payment system.
As far as the Home Health Prospective Payment System of Medicare is concerned, the Medicare recipients are entitled to receive home health care services that are only delivered by a certified home health care agency. There are also a few other requirements for a beneficiary to qualify for such benefits.
  • They must be homebound
  • Need recurrent skilled nursing and therapy services
  • Under the care of a qualified physician and
  • Need reasonable and necessary home health care services as suggested and certified by the physician
Ideally, this should be a 60-day plan of care to get both Medicare Parts A and B funds. The agencies are paid by Home Health Resource Groups or HHRGs based on their functional and clinical status. This status is drawn by the OASIS or Outcome and Assessment Information Set as well as the services used.
  • In general, Medicare will pay the first part of funds only if the home health care agencies follow the discharge planner for an acute care hospital.
  • It will pay Part B funds if only the physician refers the patient for a certified home health care service as part of their treatment plan and community-based care.
Lastly, traditional Medicare being largely FFS it is not shocking that the federal government is now looking to emphasize value over volume as well as coordination over fragmentation.
This means that now payments will be made to agencies based on the services delivered more than the quality of the care delivered as it is defined by key measures. Since providers and professionals are not historically paid for coordinating care across the continuum, they feel home health care agencies should not be an exception.