Following completion of this chapter, the reader will be able to:
Identify the qualifications for home health services under Medicare Part A and B.
Discuss what the OASIS is in home health.
Describe the role of standardized tests and instruments in home health.
Explain what a MAC is and what role do they serve in home health.
HOME HEALTH DOCUMENTATION
Providing physical therapy services in the home health setting involves creativity, flexibility, and solid documentation skills. Physical therapists need to employ their full scope of assessment skills in order to manage a medically complex individual without the support of a medical facility or quick access to individual staff.1
The legal and professional responsibility associated with documentation is an essential component of home health physical therapy. Physical therapists (PTs) and physical therapist assistants (PTAs) must stay current with continuously changing regulations and laws regardless of payer source. According to the Home Health Section of the American Physical Therapy Association (APTA), home healthcare is a medically oriented, skilled, and intermittent service provided in the home that may include nursing, physical therapy, occupational therapy, speech therapy/speech-language pathology, social services, dietary/nutrition counseling, pharmacy services, and/or home health aides.2 Performing physical therapy in an individual’s home can occur within private direct pay (outpatient physical therapy in the home), Medicare Part A (Hospital Insurance), and Medicare Part B (Medical Insurance). The physical therapist evaluates and provides interventions in the patient’s place of residence, a noninstitutional setting. These environments include the patient’s home, caregiver’s home, assisted living facility, independent living facility, group home, residential facility, or the like. Home health offers more autonomy than other settings in which PT is rendered and provides needed skilled services for individuals who have difficulty leaving their homes or prefer to be treated in their own home.3
Medicare B services may be available in the home under 2 conditions:
As OP services because of challenges of access.
An individual has not had a hospital stay or inpatient rehab, but is in need of skilled services and is essentially homebound.
Outpatient PT services covered under Medicare Part B provided in patient homes via private practice or corporate outpatient, as a result of patient preference or lack of transportation, typically follow the same guidelines as outpatient facilities and usually require a co-pay.4 Non-Medicare or non-Medicare Part B payers may limit or exclude physical therapy as a covered home health service, possibly resulting in the patient paying privately for therapy at home or being forced to obtain outpatient services. In all cases, PTs and PTAs should continue to document using principles consistent with APTA Guidelines: Physical Therapy Documentation of Patient/Client Management [BOD G03-05-16-41].5 Since documentation regarding pediatrics is covered separately in this chapter, this section will focus primarily on documentation for the geriatric patient receiving services covered by Medicare and ...