Frequently Asked Questions

Medicare pays for "skilled" services that are "medically necessary." These services are the ones that can only be (by law) provided by a licensed healthcare provider; that is, a registered nurse, licensed physical therapist or speech therapist. When care is provided by one of these licensed practitioners, the services are usually covered by Medicare. You can then also have help from an occupational therapist, home care aide or medical social worker.

As you improve or stabilize, it is not uncommon for the "skilled" portion of the care to no longer be required. For example, an unlicensed practitioner (such as a home care aide) may be fully capable of providing all of the needed services. In most instances, these "less-than-skilled" services are not covered by Medicare but can be paid for directly by you. Your nurse or therapist will inform you when it appears that skilled services are no longer required so that appropriate plans can be made.

You must also be "homebound" in order for Medicare to pay for services. To be considered homebound, there must be a normal inability to leave the home. Absence from the home must be infrequent and of short duration to receive medical care. You are NOT homebound if you leave home frequently for business, work or school.

Face-to-Face Encounter Required by Medicare

A recent change in the law adds a new requirement to qualify for Medicare coverage. The new law requires that you be seen face-to-face by the physician, or certain non-physician practitioners working with the physician, before home care services start or soon thereafter.

The key elements of this new law are twofold:

• You must have the face-to-face visit within 90 days prior to starting home care or within 30 days after the start of care. Also, the visit must be for medical service related to the reason why home care services are needed.
• The physician responsible for performing the initial certification (admission or start of care) must include the date of the encounter.

It is your responsibility to be seen by a physician within this designated timeframe.

Advance healthcare directives are spoken or written plans and information that you make about your choices for medical care. Planning and writing your advance directive lets you control your healthcare at a time when you may not be able to make your wishes known and informs healthcare providers and loved ones of the treatment decisions you have made.

In the state of Pennsylvania, there are two types of advance healthcare directives:

• Living Wills
• Healthcare Powers of Attorney

Ask about and discuss the ethics of your care with your healthcare provider, including resolving any conflicts that might arise such as, deciding against, withholding or withdrawing life-sustaining care.

It's best to provide a copy of your advance directive, living will, durable power of attorney for healthcare and any organ or tissue donation permissions to the health care professionals taking care of you.

To be eligible for home care services, below are some requirements that you may need to meet:

• You are under a physician's care.
• You require the skilled services of a registered nurse (RN) or physical therapist, occupational therapist or speech and language pathologist.
• You have difficulty leaving your home or leave infrequently.

Most home health services are covered by private insurance plans, major medical insurance, HMOs, Medicare and Medical Assistance. You are encouraged to contact the Visiting Nurse Business Office at 215.345.2202 with any questions regarding insurance coverage or the charges for our services.

You may wish to discuss payment terms or customized funding arrangements with the Doylestown Health Home Care office, at 215.345.2202. A social worker is available to assist in this process.

We provide these services without regard to race, color, religion, age, sex, national origin, physical or mental handicap, sexual orientation, or even ability to pay. We review insurance coverage and make every attempt to provide patients with information regarding copays and deductibles.

Change of Insurance Coverage

Please inform the Home Care Department if there is any change in your insurance coverage. Should you not notify us of changes, or if the information you provide is incorrect, you will be billed directly for the services provided.

If you have questions or concerns about care, please discuss them with your nurse or therapist at your visit. You can also call Doylestown Health Home Care at 215.345.2202. After hours messages (between 4:30 pm and 8 am and during weekends) will be returned the next day.

Our home health aides are an important part of our home health team. They provide compassionate personal care assistance. Other secondary duties may include laundry, straightening of patient area or even preparation of a simple meal. The usual time spent with each of our patients is one hour. Visits generally decrease in frequency as you become stronger or as you or your caregiver learn to provide this care yourselves.

Your physician, Medicare and insurance companies recognize the importance of this service. Most insurances will cover the cost if it is provided in conjunction with a nurse or therapist.

If you are concerned about your health or if your condition is worsening, please contact the on-call nurse.

In the event of an emergency, call 9.1.1.

If you are hospitalized and would like to request Doylestown Health Home Care services, please contact the hospital social worker to help facilitate home care services.

Running low on medical supplies regularly furnished by us? Please call the Home Care office (215.345.2202) promptly so that we may arrange a delivery before you run out. Please inform your nurse or therapist of any supplies you have been previously purchasing or that have been covered by Medicare prior to your home health admission.

We request your cooperation in scheduling your visits. Visit cancellations are an indication to us and to your insurance company that the aide services may no longer be of benefit to you. Multiple cancellations may result in a consultation with your physician regarding the necessity of these particular services.

If you must cancel a visit, please notify the visiting nurse or therapist in advance. If you do not cancel with at least 24-hours notice, you may be billed a cancellation fee.

We encourage you to discuss any concerns related to your care with your nurse or therapist or call our office at 215.345.2202.