Face-to-Face Encounter Documentation Update: Understanding the Homebound Requirement

Face-to-Face Encounter Documentation Update: Understanding the Homebound Requirement

Barnabas Health Home Care is committed to working with its care partners to assist in the understanding and proper completion of the Face-to-Face encounter documentation required by the Affordable Care Act to certify a Medicare beneficiary for home care services. Please see below for a summary of the criteria of “confined to home” as outlined by The Centers for Medicare and Medicaid Services (CMS) Change Request 8444.

Barnabas Health Home Care team members are available to come to your office to in-service you and/or your staff about this important CMS requirement. Please contact us to schedule an education session at a time convenient for you.

Through collaboration, we can ensure patients receive timely and appropriate access to the quality home care services necessary to assist them in recovering from a serious illness or surgery, or in managing chronic illness in the place where they are most comfortable – their home.

Essex County: Jennifer Delgado, 973-322-0355
Ocean County: Shelley Siemers, 732-818-6872

For a patient to be eligible to receive covered home health services under both Part A and Part B, the law requires that a physician certify in all cases that the patient is confined to his/her home. For purposes of the statute, an individual shall be considered “confinedto the home” (homebound) if the following two criteria are met:

Criteria One

The patient must either:
Because of illness or injury -need the aid of supportive devices such as crutches, canes, wheelchairs and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence OR Have a condition such that leaving his or her home is medically contraindicated.

If the patient meets one of the criteria-one conditions, then the patient must ALSO meet two additional requirements defined in criteria two.

Criteria Two

There must exist a normal inability to leave home AND leaving home must require a considerable and taxing effort.

If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment. Absences attributable to the need to receive health care treatment include, but are not limited to:

  • Attendance at adult day centers to receive medical care;
  • Ongoing receipt of outpatient kidney dialysis; OR
  • The receipt of outpatient chemotherapy or radiation therapy.

Patients can still be considered homebound if they are absent from the home for infrequent or short durations that can include:

  • Attending a religious service
  • Occasional absences from the home for nonmedical purposes, such as a trip to the barber; a walk around the block or a drive; attendance at a family reunion, funeral, graduation or other infrequent or unique event
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