Under CMS guidelines for Home Health Services, which condition is required?

• A. The physician must certify that treatment is necessary and personally examine the patient.
• B. The patient must be homebound.
• C. Both The physician must certify and patient homebound.
• D. A nurse must certify treatment necessity.

Answer: (C)

The key idea is eligibility for Medicare home health services hinges on two requirements: the patient must be homebound, and there must be a physician’s certification of medical necessity for the home health services (with an established plan of care). The homebound status means leaving home is difficult or does not occur except for medically necessary reasons. The physician’s certification confirms that skilled services are medically necessary and that the home health plan of care is appropriate. A nurse cannot certify medical necessity, and requiring the physician to personally examine the patient isn’t a stated CMS requirement for home health eligibility. Therefore, both conditions must be met.