Medicare Certified Home Health Care & Hospice

Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria. Medicare operates as a single-payer health care system. Medicare is partially financed by the federal government through payroll and other taxes. In general, all persons 65 years of age or older who have been legal residents of the United States for at least 5 years are eligible for Medicare. In 2008, Medicare provided health care coverage for 45 million Americans making it the largest single health care payer in the nation. Enrollment is expected to reach 78 million by 2030, when the baby boom generation is fully enrolled.

Medicare Certified Home Health Care

Medicare certified home health agencies are licensed to provide skilled include medical or psychological services, wound care, pain and medication management, disease management, nursing care services, oxygen services, medical supplies and equipment, physical therapy, speech therapy, occupational therapy and home health aide care to Medicare eligible patients. Medicare certification means that the agency has met specific federal guidelines and criteria regarding patient care. The main and purpose of this type of agency is to provide skilled care for treatment or rehabilitation services to homebound patients. Home care professionals must strictly adhere to a physician approved plan of care that is deemed medically necessary and updated every 60 days in order for Medicare benefits to continue. Home care services generally are available 24 hours a day, 7 days a week.

Many are also accredited by independent third-party review organizations such as ACHC, CAHPS, FHHC, and JCAHO. Services are generally paid for by Medicare, Medicaid, and Private Health Insurance and must patients must meet strict criteria for participation and payment authorization. There are approximately 9,800 licensed Home Health Care Agencies operating nationwide.

Hospice Care

Hospice care is a specialized type of skilled home health for individuals needing compassionate, end-of-life services. All persons regardless of age who have a life-threatening or terminal illness may receive hospice care. Most reimbursement sources require a prognosis of six months or less if the illness runs its normal course. Patients with both cancer and non-cancer illnesses are eligible to receive hospice care. This type of care involves a core team of skilled experts and volunteers who provide all-around medical, psychological, and spiritual care when cure is no longer possible. Specifically, these services include pain management, palliative care, social/psychological support and chaplain services for the patient and their family. It is usually based at home so that families take part in the patient's care. Trained hospice professionals are available 24 hours a day. They help the family care for the patient, ensure that the patient's wishes are honored, and keep the patient comfortable and free of pain. Most states require Hospice Agencies be license. Hospice services are generally paid for by Medicare, and patients must meet strict criteria for participation and payment authorization. There are approximately 8,400 licensed Hospice Agencies operating nationwide.

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