Tips for Documenting Homebound Status
Comprehensive and accurate documentation is crucial to providing safe and effective care to Medicare beneficiaries. National Government Services' medical review team reviews this documentation while making claim determinations. Our reviewers are able to determine the criteria throughout the documentation supports the beneficiary met the requirements for homebound status eligibility.
A beneficiary would be considered homebound if the following information is documented in the medical record and is specific to the beneficiary:
The medical records demonstrate one of the following statements is true:
- There is a need for an assistive device or human assistance to leave the home.
- Examples: Use of cane, walker, wheelchair, crutches, hands-on assistance from another person, gait belt, contact guard, or wheelchair follow for safety.
OR
- It is medically contraindicated for the beneficiary to leave the home.
The medical records demonstrate that in addition to one of the statements above, both of these statements are true:
- There is considerable and taxing effort to leave the home.
- Documentation must support why it is a taxing effort. Examples of why: pain, fatigue, weakness, dizziness, loss of balance and unsteady gait, shortness of breath, agitation, need for rest after so many feet or minutes of activity.
AND
- There is a normal inability to leave the home.
- Examples of why: medical restrictions or precautions such as spinal precautions or weight bearing restrictions, vision deficits, cognitive issues, or high infection risks.
Documentation must be beneficiary specific. It is recommended that you do not use standardized phrases or repeat the words “taxing effort to leave the home” as these phrases are insufficient. Documentation should be in clear and specific terms, not inferred.
Other helpful documentation to support homebound status should include but is not limited to, the patient’s diagnosis, duration of the condition, clinical course, prognosis, nature and extent of functional limitations, other therapeutic interventions, etc.
Common Question: Does a certain distance of ambulation make someone not homebound?
Answer: No, there is no specific distance for a beneficiary to ambulate that would make them no longer homebound. However, based on the clinical picture, some distances may suggest that the beneficiary is not homebound, especially if the documentation lacks considerable and taxing effort during that ambulation distance documented.
For example: A beneficiary is ambulating (XX) feet on outdoor terrain without mentioning pain limitations, fatigue, dyspnea, a limited range of motion impairing overall functional mobility, impaired balance, or need for rest to recover (explicitly defined in the documentation).
A beneficiary may leave home and still be considered “homebound” if they don’t leave their home often or if they only leave for a short time for health care services, religious services, adult day care, or other unique or infrequent events (for example, funeral, graduation, barber, or hairdresser services).
Related Content
- Home Health Eligibility
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 30.1
- MLN® Educational Tool: Medicare Provider Compliance Tips: Home Health Services
- Medicare.gov: Home Health Services
- 42 CFR 484.55
Posted 10/16/2023