Home Health Visits

Perhaps you saw a recent article by reporter Barbara Martinez in the Wall Street Journal concerning the Medicare Home Health benefit. The article suggests that home health agencies make therapy visits to Medicare beneficiaries not strictly according to their medical condition, but also according to Medicare reimbursement rules. It says that where Medicare payment rules have a “tipping point,” that is, a certain set number of therapy visits where, if the agency exceeds this number of visits, it gets a higher reimbursement amount, agencies tend to go ahead and give those extra visits. And, of course, claim the extra reimbursement. The Home Health Agencies say there are other factors driving this.

Strictly from the beneficiaries’ point of view, this probably tends to incentivize the agencies to have therapists – whether occupational or physical – make more visits to you than they otherwise might. And to the extent that these visits truly improve your condition, this would be good for you, because, as laid out in the section of Managing Your Medicare on home health (see pages 133-137), you don’t have to pay anything for home health visits. But what the article also indicates, although not as explicitly, is that changes in Medicare reimbursement rules have also caused a decrease in other types of visits, both skilled nursing visits and medical social services visits. And this would result in your getting fewer of these kinds of visits than you might otherwise receive, which might not be the best thing for you.

Perhaps the upshot of this is to remind beneficiaries and their caregivers that they have the right to get an independent review of the cut-off of home health visits. This is fully explained the appeals chapter, on page 199. So if you think your visits are being cut off before they should be, appeal at once to the Quality Improvement Organization in your state.