4. The patient/client must require skilled care. a. Skilled services are those which are medically reasonable to the treatment of the patient’s/client’s illness or injury at a reasonable frequency to meet the patient’s/client’s need. Skilled care is care that requires the skills of a licensed nurse, physical therapist, or a speech therapist, or the ongoing care of an occupational therapist. b. Skilled nursing services must be intermittent. There must be a medically predictable and recurring need for care which would require more than one skilled nursing visit. c. Medicare will pay for daily skilled nursing visits for approximately three weeks. Daily skilled visits are defined as seven days a week. Orders for daily skilled visits for longer than three weeks of care other than insulin administration must have an end-in-sight documented. d. Home health aide visits can only be performed when a skilled service is being provided by an RN or LVN/LPN, PT, ST, or continuing an OT. e. Venipuncture is not a qualifying skill. It is a covered/billable service if another qualifying skill is provided. f. Feeding a patient/client through a G-tube is not considered skilled. 5. Care must be reasonable and necessary. a. Skilled services are those services that are reasonably necessary to the treatment of a patient’s/client’s illness or injury. 6. The patient/client must have a face-to-face (F2F) encounter. MLN Matters Number: SE1219 provides the below F2F information. a. Face to Face Requirements: i. For initial home health certifications only, the certifying physician must document that the physician himself or herself, an allowed non-physician provider (NPP), or another physician caring for the patient/client in an acute or post-acute facility who has privileges at the facility had a face-to-face encounter with the patient/client. ii. The face-to-face encounter must occur 90 days prior to the home health start of care date or within thirty days after the start of care. iii. The inclusion of the physician’s F2F encounter note is a requirement. iv. Prior to billing, the home health agency should ensure that all certifications are complete to include the face-to-face documentation that has been clearly titled, dated, and signed by the certifying physician.
