Most major medical policies from private insurance companies contain home healthcare provisions of coverage; verification and pre-authorization for home healthcare services is required in writing.
- MEDICARE PART A services are those provided within the patient's home. The allowable charges for these services are reimbursed 100%.
- MEDICARE PART B covers therapeutic services provided within a nursing home and outpatient rehab services. The allowable charges for these services are paid at 80% with the remaining 20% payable by the client or his supplemental insurance. The agency may write off this 20% when the source of payment is not collectible.
- MEDICAID covers persons who are certified to be needy and who do not have coverage under Medicare; services are limited to 50 visits annually by skilled nurses, physical therapy and certified nursing assistants combined.
All approved home healthcare services are billed to Medicare Part A on your behalf and paid 100%. Part B services are paid on your behalf at the rate 80/20 (for non-homebound patients). Private insurance payments are negotiated with different companies for pre-approved services.