A Taxing and Considerable Effort

I’ll be honest with my faithful readers. It requires a considerable and taxing effort for me to leave my home. Sometimes, I even need the assistance of another person to carry my computer, suitcase, etc. if I am leaving town to visit a client. In the heat of the summer, I clearly do not tolerate it well. You can just look at me in the near 100 degree temp wilting and know that it was a major event for me to leave my house. Yes, indeed. Some might even say I meet the Medicare homebound standards.

But, obviously, I do not. And that’s okay because nobody is billing for services provided to me in my residence. But do your patients truly meet the homebound criteria?

There are patients who are bedbound and those you discharge because they drove in behind you when you were making a visit. Everyone else is in a grey area.

Medicare expects that most times when a patient leaves the home it will be for the purpose of receiving medical treatment. Attending worship services is also acceptable under the home bound criteria. Other than those instances, Medicare does allow occasional and infrequent absences for the purposes of socialization, etc. A patient who shops with their daughter a couple of times a month may not violate the homebound criteria. And if they take an occasional walk around the block and go get their hair done, they can still be considered homebound. But what about the patient who shops on Monday, walks on Tuesdays and Thursdays and gets their hair done on Fridays?

When establishing the homebound criteria for patients, we are acting as advocates as patients. We know that patients need services and we try to fit the activities of their daily lives into a vague and inexact definition given to us by CMS. Now pretend you are a surveyor working to prove the patient isn’t homebound. What questions would you ask?

1. How often do you leave home?
2. What do you do when you leave home?
3. Is it difficult for you when you leave home?
4. Has anyone told you that you must stay home if you want to receive your home health services?

These are the questions I would ask. And the answers will not eliminate all confusion. For instance, what about the patient who walks to the corner every day to buy fast food because his kitchen appliances are malfunctioning and there is no one else to go buy him food? What about the patient who lives in a rural area without a car and there is no public transportation? What happens when the patient is too proud to allow family members to drive him to church on Sundays or if the near blind dialysis patient who drives herself to dialysis occasionally when her family doesn’t show up to take her?

There are no easy answers to these questions. Without interviewing the patient to gather all facts, it is impossible to confidently state that any of the above patients are homebound. But beware. There is more than one agency looking to deny your claims because patients are not meeting the home bound criteria.

We are available for clinical review should you need an outside opinion on the homebound status of your patients. Please feel free to call 225-253-4876 or email us if you need assistance.