If you are running a home health agency, you may struggle to be reimbursed by the Federal government through Medicare. If this is the case, you should consult with Medicare reimbursement solutions.

The Professional Background of Medicare Reimbursement Consultants 

Navigating regulations related to Medicare reimbursement can be challenging without the help of consultants. Medicare reimbursement services consist of a whole team of specialists including former Medicare auditors, former hospital controllers, and CPAs. these professionals will help you improve your cash flow by receiving compensation through Medicare.

Services a Consultant Will Help You With

The consultant will help you with Medicare coding, billing, documentation, and audits. Medicare does not accept claims and instead requires that all of the services be billed using the correct E/M code. You will need to provide sufficient documentation to prove that the patient actually received your services.

How to Appeal a Medicare Decision

If Medicare makes a decision, a consultant will assist you in appealing the decision. One of the most common reasons why Medicare might deny a claim is if they believe they do not cover the particular services you have provided to the patient.

For example, Medicare will not pay for meals provided to the patient, 24-hour care, cleaning, laundry, bathing, dressing, or other homemaking and personal care services. However, services that are directly related to care provided by a doctor can be billed to Medicare for reimbursement.

How a Patient Qualifies for Medicare

Types of services that Medicare might reimburse you for include physical therapy, the injection of medication for osteoporosis, part-time skilled nursing care, part-time home health aid services, occupational therapy, and medical social services.

The patient must be under the care of a doctor and the services must be provided under a plan that was created by the patient's doctor. The doctor must also certify that the patient is homebound. 

Meeting the Homebound Requirement

The "homebound" certification is only relevant if the patient is covered under Medicare. This type of certification means that the patient will need medical equipment to be able to leave their homes, such as a wheelchair or crutches. The doctor will need to determine that it is difficult for the patient to leave their home or that they are unable to do so unless there is an emergency.

The patient is still allowed to leave their home under some circumstances such as to go to the doctor or attend religious services. As long as the patient is homebound and meets other requirements, a Medicare reimbursement service will be able to help you receive compensation for the care you have provided.