Documenting Homebound Status
New Requirements for 2011
Beginning this year, Medicare will require notes from the doctor about homebound status as part of the documentation of the newly required face-to-face encounter. Pulse will help doctors easily submit this documentation as an addendum to the normal plan of care. The addendum will query ‘Based on clinical findings of this encounter, this patient meets the definition of homebound because:’. CMS specifically prohibits home health agencies from typing the answer to this question for each patient and then letting each doctor sign off on it. Doctors must provide free form answers to this question. To provide further assistance with this new documentation requirement, and for a good general review, we offer a few notes on Medicare’s homebound requirement for home health patients.
Medicare defines homebound as “there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort.” “Absences from the home are infrequent and of short duration.” Bear in mind that federal regulations stipulate that patients may leave the home infrequently. Federal manuals state that as long as absences from the home are infrequent, none of the following outings will necessarily disqualify a person from home health services:
Any religious service
- Adult day care services
- A drive
- Family reunions, funerals, graduations
- Occasional trips to the barber
- Walks around the block
Federal guidelines give these examples of patients who would be considered homebound:
- People requiring the use of crutches, canes, wheelchairs, walkers, or human assistance to leave the home
- Senile patients
- Patients who have lost the use of an upper extremity and may be limited in the use of stair handrails
- Patients with limited ability for ambulation due to pain and/or weakness
- Patients with heart disease who must avoid stress
- People for whom outings may be medically contraindicated as determined by the physician
When documenting homebound status, it can be beneficial to cite how the current medical condition may relate to the homebound status:
- Patient requires crutches to leave the home secondary to stroke.
- Home health diagnosis has left patient in weakened state, and patient requires human assistance to leave the home.
- Temporary loss of use of upper extremity makes unnecessary trips away from the home contraindicated.
- Current state of heart disease makes potential stress of leaving the home contraindicated.
- Patient is senile and requires human assistance to leave the home safely.
Many geriatric patients recovering from injury or illness will meet Medicare’s homebound requirement. If you ever have questions about a specific patient or a general concern, please do not hesitate to call us.
Fast Response to Referrals
Whether it’s lymphedema, home infusion, or just observation of a condition likely to worsen, you shouldn’t have to wait days for home health care to begin. When you need a prompt response to referrals, rely on Pulse.
Please offer Pulse Home Health Care to your patients.