Skilled Nursing (answering "yes" to just ONE may qualify you for skilled home care):
Wound care?
Diabetic care and teaching (trouble with diabetes and sugar levels)?
Medication management (education on medications/side effects/how to take them)?
Foley catheter changes? Colonoscopy care?
Tube feedings?
Post-op care and teaching?
Blood draws (recently put on a blood thinner such as Coumadin)?
Physical Therapy (answering "yes" to just ONE may qualify you for skilled home care):
Any falls in the last year?
Pain in limbs, back or neck?
Difficulty with getting out of chair or bed (transfer training)?
Trouble with incontinence? (this can also fall under Occupational Therapy)
Feeling dizzy?
Trouble with walking?
Osteoporosis affecting their function?
Need assistive device training?
Poor balance (stumbles, walks holding onto furniture or looks unsteady)?
Weakness, poor endurance, tired doing things around the house/facility or tired from an occasional outing?
Occupational Therapy (answering "yes" to just ONE may qualify you for skilled home care):
Low vision?
Complaints of dizziness?
Difficulty with eating, showering or dressing and needs adaptive equipment to facilitate?
Difficulty with being able to cook and do activities around home safely and independently (activities of daily living, strengthen cognitive skills)?
Speech Therapy (answering "yes" to just ONE may qualify you for skilled home care):
Problems with choking or coughing when they swallow food, liquid or pills?
Pneumonia one or more times?
Difficulty with memory that affects daily life?
Difficulty with finding the right words that effects their quality of life?
Trouble with the quality or sound of their voice, or understanding speech?
*These are examples of Non-Skilled Services*
Companionship
Light housekeeping
Meal preparation
Daily household chores
Assistance with bathing and grooming
Transportation
*Medicare Part A Home Health benefits cover skilled services at 100%, as opposed to Outpatient Part B! You can utilize Part B benefits of your plan for therapy needs if you are NOT homebound as Outpatient Therapy, covered at 80% after deductible.*
Here are a few important things to remember:
?Non-skilled services are paid for privately or by certain long-term insurances, Medicaid or other insurance plans, and are billed at hourly, nightly or live-in care rates. These services can be ongoing when a resident cannot learn or manage activities even with skilled services.
?Skilled services require a licensed clinician and resident needs must be medically necessary and are most often paid by Medicare or other insurances. If you are considered to be homebound, Medicare covers skilled services at 100% (Part A).
?Medically necessary means that if the skilled clinician did not perform services, there would be a decline in patient's function or health and that the clinician's skill set in their field is necessary to make a difference.
?Licensed clinicians for skilled care are RN's and LPN's. Freedom Home Health uses only RN's who have the education and license to evaluate clients at each and every visit, and uses only licensed therapists rather than assistants for that very same reason.
?To qualify for skilled home care, client needs to be classified as homebound status (Medicare Part A), client needs skilled services, needs must be medically necessary, client's physician certifies the need for home care, and client receives care from a certified home health agency.
?Homebound means leaving the home requires a considerable and taxing effort; taxing effort can mean that you need help from another person, that you need crutches, walker or wheelchair, or that you are fatigued after going out and need considerable time to rest. A person can still go out of the home and be considered homebound; examples include but are not limited to attending a family event or funeral, spiritual obligation or doctor's appointment.
?Skilled vs. non-skilled: skilled visits are per visit, per clinician and agencies are given a set dollar amount per patient, per plan of care. Non-skilled visits are hourly rates and can be up to 24 hours a day. Skilled agencies have to follow the rules of Medicare exactly to keep their certification to bill Medicare and other insurances. Non-skilled agencies do not have to report to any agencies or go through a certification process.
Information provided by Freedom Home Health of Columbus. More information can be found at freedomhomehealth.com freedomhomehealth.com
Freedom Home Health
5930 Wilcox Place, Suite D | Dublin, OH 43016
614-336-8870
freedomhomehealth.com freedomhomehealth.com
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