Page 102 - CHHA Binder 2.3.20

4/11/2019

Reimbursement: Medicare

 Part C
• Medicare Advantage Plans
 Covers services of both A & B

 VNS Choice and other HMO’s

 Part D
• Medication Prescriptions

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Eligibility at VNSNY

 Primary skilled nursing care or physical therapy need on
an intermittent basis while being homebound.

 For Medicare purposes…
o “Intermittent”
• Services can be provided daily for no longer than 21 days
• Must have a predictable end date
• End date must be reasonable
o “Homebound”
• Must have a medical illness or injury where it is difficult for patient to
leave home, requiring the assist of another person and/or device
• Requires a considerable and taxing effort to leave the home
• May attend religious event or family celebration, medical appointments,
medical adult day care, & walk around the block if performed
infrequently and with assistance

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