What “Confined to the Home” Means Under Medicare

The Centers for Medicare & Medicaid Services (CMS) has revised the Medicare Benefit Policy manual to clarify its definition of a patient as being "confined to the home" under the Medicare home health benefit.

The change aligns CMS' definition more accurately with that in the Social Security Act and eliminates vague phrases like "generally speaking."

The revision, which will become official Sept 2. 2014, will appear in the manual's Chapter 15 Covered Medical and Other Health Services, Section 60.4.1 Definition of Homebound Patient Under the Medicare Home Health (HH) Benefit.

For a patient to be eligible to receive covered home health services, the law requires that a physician certify in all cases that the patient is confined to his or her home by meeting certain criteria, and needs skilled services.

CMS' revision clarifies that if the patient does in fact leave the home, he or she nevertheless may be considered homebound if the absences from the home are:

  • Infrequent or of relatively short duration, for example:
    • Any attendance at a religious service;
    • An occasional trip to the barber;
    • A walk around the block or a drive; or
    • Attendance at a family reunion, funeral, graduation, or other infrequent or unique event; 
     

OR

  • Attributable to the need to receive health care treatment, including but not limited to:
    • Attendance at a state-licensed, -certified, or -accredited adult day center to participate in therapeutic, psychosocial, or medical treatment;
    • Ongoing receipt of outpatient kidney dialysis; or
    • The receipt of outpatient chemotherapy or radiation therapy.
     

The aged person who does not travel often from home soley because of feebleness and insecurity brought on by advanced age would not be considered confined to the home.

For details about this change in the Medicare Benefit Policy manual,  see CMS' MLN Matters No. MM8818 (PDF).

Billing tip: Medicare says it has identified overpayments for home health claims, most of them due to insufficient documentation of the face-to-face encounter required prior to certifying a Medicare patient's eligibility for the home health benefit. Review what elements you must document.

Posted Aug. 12, 2014

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