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Do Medicare Providers Make House Calls?


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House calls are making a reappearance in many regions of the United States, according to the Washington Post. A growing number of these house calls are from Medicare providers – like nurse practitioners, home health aides, physical and speech therapists, and doctors. Normally, of course, you either go to a doctor’s office or clinic, or stay in a nursing home or other facility, to see a Medicare provider.

Medicare providers making house calls as part of a demonstration project

The Centers for Medicare & Medicaid Services (CMS) launched a demonstration project called the Independence at Home program where Medicare providers make house calls for patients who have multiple chronic conditions.

Participation in this pilot project is voluntary for Medicare beneficiaries. You must have at least two chronic health conditions, need help with at least two functional dependencies (such as walking or eating), and meet certain other criteria to qualify. One group of Medicare doctors and 12 independent practices in 11 states participate in the project. It began in 2012, and runs through December 31, 2020.

Why would Medicare providers make house calls?

If Medicare providers made house calls to people with chronic conditions, patients might get better care and have better outcomes, CMS reported. CMS will use this pilot project to see if house calls (home-based medical care) can help patients avoid hospitals and emergency rooms. Medicare provider house calls might boost satisfaction for both patients and caregivers. CMS also wants to see if the program saves money for the Medicare program (for example, by reducing hospital and emergency room visits).

Medicare providers making house calls: how do the results look so far?

The Centers for Medicare & Medicaid Services (CMS) reported a savings of about $16,300,000 after the first three years. That works out to an average savings of $1,431 per applicable beneficiary.

But in some cases, results were more dramatic, according to the Washington Post. Housecall Providers of Portland, OR reported a savings of almost $13,600 per patient after the first year of the Independence at Home program. And Housecall Providers had been operating at a loss, the Post added. And a house call practice called MedStar Washington Hospital Center saved an average of $12,000 per patient through the program.

How are Medicare providers paid for making house calls?

Medicare providers participating in the program are paid “about the same” as for an office visit, the Washington Post reported. But the pay doesn’t include travel time or extra time needed for complex care.

But there are incentives for Medicare providers who make house calls as part of the project, CMS reports. If a Medicare provider/practice achieves both of these with participating patients, the provider may get an incentive payment:

  • Meets specified quality performance standards
  • Reduces Medicare costs below the usual expected Medicare-approved amount for services

Does Medicare pay for Medicare provider house calls?

Outside of the Independence at Home program, Medicare may pay a portion of Medicare provider house call services – that is, home health care – under certain circumstances.  This may be the case whether you have Medicare Part A and Part B or you are enrolled in a Medicare Advantage plan. Typically you must receive home care from a Medicare provider (a provider who accepts Medicare assignment). You must also meet Medicare criteria to qualify for home care.

Under Medicare Part A, you have coverage for home-based hospice care. In addition, Medicare Part A and Part B provide benefits for a wide range of intermittent skilled nursing services, therapy, medical supplies, medical social services, and even health aide services to assist you with daily living activities such as dressing or bathing in your own home. Usually these services are provided by Medicare-approved home health agencies for periods of up to 60 days. Whether you are enrolled in Medicare Part A and Part B or a Medicare Advantage plan, you must qualify for home health services.

How do I know if I qualify for home health care (house call) coverage outside the pilot program?

To use your Medicare home health benefits, you must be homebound — that is, unable to leave home without considerable effort, unaided or at all. Your doctor must certify that you need home-based professional services from a Medicare provider and you must have a treatment plan that is regularly reviewed by a doctor.

What does Medicare not cover in house call services?

  • Medicare typically does not cover:
    Custodial (such as help dressing or bathing)
  • Long-term care
  • Not medically necessary

If you would like to learn more about Medicare providers or your options for Medicare coverage, feel free to contact eHealth and speak with a licensed insurance agent. To research Medicare health plans available where you live, simply enter your zip code and press the button on this page.

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