Question 1

What's the difference between Medicare home health and private home care?

Accepted Answer

They're not the same thing, and getting them confused is the most common reason people end up frustrated with the wrong agency. Medicare home health is skilled clinical care: nursing, physical therapy, occupational therapy, wound care, infusion. It's paid by Medicare and ordered by a physician. Private home care is non-medical help: bathing, cooking, transportation, companionship. It's paid out of pocket or through long-term care insurance. Most patients on home health also need some private home care alongside it. We handle the skilled side; we'll warm-hand you to our sister company #1 Home Care Services for the rest.

Question 2

What does "homebound" actually mean?

Accepted Answer

Homebound is a Medicare requirement, not a synonym for bed-bound. It means leaving the home takes a considerable and taxing effort, and that the person doesn't leave routinely. They can still go to a doctor's appointment, attend church, or step out for a walk. They just can't be running errands or going to work. We confirm homebound status during the start-of-care visit and document it for Medicare.

Question 3

What's the difference between physical therapy and occupational therapy?

Accepted Answer

Physical therapy works on getting back to mobility: strength, balance, walking, stairs, the bigger gross-motor pieces. Occupational therapy is about the activities of daily living: being able to safely shower, dress, cook, use the bathroom. They overlap, but they're not interchangeable. Most of our patients receive both.

Question 4

How long does Medicare home health last?

Accepted Answer

Each Medicare home health episode is a 60-day certification period. If you still need skilled care at the end of those 60 days, the physician can re-certify for another 60. There's no hard limit on the number of recertifications, but at every certification point we have to show that skilled care is still medically necessary.

Question 5

How fast can care actually start?

Accepted Answer

If you have traditional Medicare (Part A/B), most referrals are seen the next day. Once the referral comes in, we run your benefits, confirm homebound status, and call you with the welcome call to schedule. Medicare Advantage takes a little longer because we have to clear prior authorization with your plan. Sometimes that's a day, sometimes a few days. We'll tell you exactly where you stand once we know your plan.

Question 6

What happens on the first visit?

Accepted Answer

The start-of-care visit is the longest one, usually 60 to 90 minutes. A clinician completes the assessment Medicare requires, reviews medications, and walks through your home looking for fall risks: broken furniture, loose rugs, missing grab bars, anything that's going to put your loved one at risk. Whatever they see comes back to you with a recommendation. By the time they leave, the rest of the schedule for the episode is on the calendar.

Question 7

What if Medicare doesn't cover something I need?

Accepted Answer

We'll tell you up front. If you need help with bathing, transportation, or homemaking, that's private home care, and we'll connect you with our sister company #1 Home Care Services. If you need durable medical equipment like a walker, hospital bed, or oxygen, we'll connect you with #1 Medical Supply. Same family of companies, no cold call, no surprise charge.

Question 8

How are you different from other home health agencies?

Accepted Answer

Two things. First, continuity of care: the clinician who walks through your door on visit one is the same clinician who walks back for visit two. Most agencies can't deliver that. Schedules shift, clinicians rotate, the family ends up explaining the whole situation again every visit. Second, we're a real Florida company, family-owned, with sister brands that cover the gaps Medicare doesn't pay for. We don't disappear after the first 60 days.

Question 9

How fast can you start a same-day discharge?

Accepted Answer

For traditional Medicare, most discharges are in the home the next day. We can usually do same-day if the referral comes in early enough and the patient lives within our core service area. Send the referral, we run benefits, confirm homebound, and call the family with the welcome call to schedule. Medicare Advantage requires prior authorization, which adds a day or two. We'll tell your team exactly where the auth stands as soon as we have it.

Question 10

What do you need to start the plan of care?

Accepted Answer

The physician's order with face-to-face encounter note, hospital discharge summary if applicable, current medication list, and insurance information. If you're missing pieces, send what you have and we'll work the gaps on our end: chasing the F2F, securing the 485, contacting the secondary payer. Your team has done its job once the referral hits our fax.

Question 11

Which EHRs and referral systems do you accept?

Accepted Answer

Direct fax, email referrals to our intake line, and the major referral platforms (Brightree, CareConnect, Forcura). If your hospital uses something we're not yet connected to, ask your liaison. We'd rather add the integration than miss your patients.

Question 12

Are you in-network with Medicare Advantage plans?

Accepted Answer

Yes. We're contracted with the major Medicare Advantage plans operating in our service area. Prior authorization is a plan-by-plan story, so we'll verify the auth window for each patient and report back before scheduling.

Question 13

Do you accept patients in ACOs or value-based contracts?

Accepted Answer

Yes. We work with ACO and value-based contracts and report quality measures into the same framework Medicare uses for the Home Health Value-Based Purchasing program. If your ACO has specific reporting requirements outside the standard measures, tell your liaison and we'll meet you where you are.

Question 14

What if my patient also needs more than skilled care?

Accepted Answer

We coordinate the non-skilled side too: private-duty caregiving (bathing, cooking, transportation), durable medical equipment, and placement support. So your patient doesn't fall through the gaps when Medicare home health isn't enough on its own. One referral to us, one warm hand-off, no separate intake calls back to your team.

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