Module 37
In this lesson, you'll learn the essentials of Medicare billing for skilled home health care, focusing on the complexities that set it apart from other payer types. Unlike fee-for-service models used by Medicaid and VA, Medicare billing follows the patient-driven grouping model (PDGM), where reimbursement is based on patient conditions and other factors like admission source, timing, clinical grouping, functional impairment, and comorbidities.
To bill for Medicare, you must first verify a patient’s eligibility, confirm they are homebound, and ensure that a physician has provided a face-to-face certification. Billing occurs in 30-day cycles within 60-day episodes, with a mandatory Notice of Admission (NOA) to be filed within the first five days of admission. The lesson highlights the importance of working with experienced Medicare billers to avoid delays and mistakes that could jeopardize reimbursement.
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