WHAT ARE THE STANDARD BILLING AND PAYMENT PRACTICES?
- Home Health Agencies
- Hospices
- Homemaker and Home Care Aide Agencies
- Staffing and Private-duty Agencies
- Pharmaceutical and Infusion Therapy Companies
- Durable Medical Equipment and Supply Dealers
- Registries
- Independent Providers
When Medicare and/or Medicare cover services, home care providers must bill their fees directly to the payer to Medicare or Medicaid. Providers often will bill other third-party payers directly as well. Any uncovered costs are later billed to the client. However, if a client receives services for a registry or independent provider, he or she must pay the provider directly. Later the client may file for reimbursement from the insurance company if the services qualify as covered benefits. Payment options are detailed below.
Home Health Agencies
Medicare, Medicaid, and most private insurance plans pay for services that home health agencies deliver. Payment from these sources depends on whether the care is medically necessary and the individual meets specific coverage criteria. Individuals may opt to pay out of the pocket for services that are not covered by other courses. Some agencies receive special funding from state and local governments and community organizations to cover the costs of needed care when other options are not available.
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