How Does Medicare Work?

How Does Medicare Work?

Client Handbook

How Does Medicare Work?

The following three items are required for Medicare to pay for your home health care services:

  1. You are homebound. This means that due to your illness or injury you are unable to leave home without considerable taxing effort and absence are short and infrequent. Trips are usually for medical reasons. If you are able to drive, or leave home without any help then you probably do not meet the home bound requirement.
  2. You have had a recent illness or injury or worsening of a condition which requires the skilled services of a registered nurse or therapist.
  3. You are under the care of a doctor who has ordered the treatment or services we are providing.

If the services are not medically necessary and specifically ordered by your doctor, Medicare will not pay for those services.

Care is provided on an intermittent basis (Home Health Visits). This means Medicare will not pay for our health care staff to stay with you for an extended period of time (Private Duty). We will only visit you for the length of time it takes to provide the specific treatment ordered by your doctor.

We will accept Medicare assigned payment as payment in full for the services we provide as long as you meet the qualifying requirements and the services are covered by the Medicare program. If services ordered are not covered by the Medicare program, you will be notified by the agency in advance so that you can make other financial arrangements for the necessary care. If you are receiving Medicare benefits, you may receive (from Medicare) a monthly Medicare summary notice listing charges billed to Medicare. This is not a bill.

American Home Health owns and operates Midwest Healthcare Associates. Midwest Healthcare Associates (doing business as American Home Health) is the Medicare Certified entity for American Home Health. Explanation of Benefits from Medicare will state Midwest Healthcare Associates. You may access our outcome information at; go to health care compare, type in Midwest Healthcare Associates.

If you have questions or concerns about your financial liability, which are not answered by our staff upon admission, please do not hesitate to call our billing department.

Please notify the agency immediately if you decide to enroll in a Medicare or private HMO or Hospice. Medicare may not pay for the services we are providing if you are enrolled in an HMO or Hospice.