If you are in the hospital:
The hospital social worker or discharge planner will generally arrange for a Medicare home health agency to visit you in the hospital and assess your condition to determine if you qualify for Medicare-covered home health care.
If you are at home:
Talk to your doctor about your home health needs and ask your doctor for names of Medicare-certified home health agencies.
Your doctor may have a list of local Medicare-certified home health agencies (HHAs) or you can get one from your hospital discharge planning office, the Yellow Pages, or the Eldercare Locator. Generally, you or your doctor’s office can call the HHAs directly and ask them to come to your home and assess your condition to determine if you qualify for Medicare-covered home health care.
No matter where you are:
In either situation, the HHA will evaluate your home health needs and draw up a plan of care. Your doctor must also complete a certification stating that you qualify for Medicare home care, and that a plan of care has been made for you that will be reviewed on a regular basis by your doctor.
As part of the certification, your doctor must confirm that you have had a face-to-face meeting with your doctor or other provider related to the main reason you need home care. This face-to-face meeting must be within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your physician must specifically state that the face-to-face meeting confirmed that you are homebound and qualify for intermittent skilled care.
The face-to-face encounter can also be done through telehealth. In certain areas, Medicare will cover examinations done for you in specific places (doctors offices, hospitals, health clinics) through the use of telecommunications (such as video conferencing).
The plan of care and certification will last up to sixty days. If you still need more care after that, the plan of care and certification can be renewed for as many 60-day periods as you need as long as your doctor signs them. A face-to-face meeting is not required for re-certification.