Frequently Asked Questions
Pristine Care Home Health Services, Inc. provides both skilled and non-skilled (ancillary) home health services. Skilled services include skilled nursing, physical therapy, occupational therapy, and speech therapy, while non-skilled services include medical social work and home health aide. You must have one qualifying skilled service (i.e. skilled nursing or therapy) to be eligible for home health. Home health may also provide medical equipment and supplies.
Examples of skilled home health services that Pristine Care Home Health Services, Inc. provide include (but not limited to):
- Wound care
- Ostomy care
- Urinary catheter care
- Diabetic care
- Intravenous therapy
- Enteral therapy
- Nutrition therapy
- Monitoring serious illness and unstable health status
- Home Physical Therapy to improve gait, balance, strength, decrease fall risk
- Home Occupational Therapy to improve fine motor skills, use of equipment
- Home Speech Therapy to improve speech, swallowing
- Patient and caregiver education
Examples of non-skilled home health services that Pristine Care Home Health Services, Inc. provide include:
- Medical Social Work to refer to community resources, in-home support
- Home Health Aide for personal care, assistance with activities of daily living and instrumental activities of daily living
Please take note that non-skilled home health care by itself will disqualify you or your loved one from home health care. You must have one on-going skilled service in addition to the non-skilled service for you to qualify.
Please CONTACT US to inquire if we provide home health care other than those listed above.
Home health care is provided to a patient’s place of residence. The residence can be a private home or residential care for the elderly (e.g. board and care and assisted living facility).
You or your loved one can receive home health care if the following criteria are met:
- Face-to-face encounter with your physician (or non-physician practitioner such as nurse practitioner or physician assistant under the supervision of your physician) within 90 days before care is initiated, or within 30 days after care is initiated
- Under the care of a physician (MD, DO, or podiatrist) who establishes and regularly reviews your personal plan of care, and certifies that you have medical necessity and you are homebound thus requiring home health services
- Medical necessity requiring one or more of these:
- Intermittent skilled nursing care (other than just drawing blood)
- Physical therapy, speech-language pathology, or occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
- You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or
- Leaving your home isn’t recommended because of your condition, and leaving home requires considerable and taxing effort
Yes. After your doctor refers you to Pristine Care Home Health Services, Inc., one of our staff will come to your home to assess your needs. We will communicate with your doctor to discuss the assessment and work together to develop your personal plan of care. Our staff will implement your physician-ordered plan of care and keep your doctor updated about your progress. If your home health needs and medical condition change, we will collaborate with your doctor to review your plan of care and make any adjustments as deemed necessary.
A home health episode of care is 60 days, on a part-time or intermittent basis. The frequency of home health care visits and the services provided are based on your doctor’s orders in your personal plan of care. Your doctor may change your plan of care, increasing or decreasing the number of visits or services provided, in order to provide you with the best home health care for your needs. If your personal plan of care goals has been achieved before the end of the 60-day episode, then you will be discharged. However, if you continue to require skilled care at the end of the 60-day episode, then your doctor may order to continue home health services beyond 60 days.
Medicare may pay for your covered home health care for as long as you’re eligible and your doctor certifies that you need it. Additionally, Medi-Cal, Covered California or your private insurance also may cover home health care, or some services that Medicare doesn’t cover. Check with your insurance company to learn about their specific eligibility requirements.
Your costs in Original Medicare:
- $0 for home health care services.
- 20% of the Medicare-approved amount for durable medical equipment.
Before you start getting your home health care, our staff will discuss with you the payment options you have, how much Medicare (or your other insurance) will pay, and tell you if any items or services they give you aren’t covered by your insurance, and how much you’ll have to pay for them.
Medicare doesn’t pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services and personal care (if these are the only services you need)
Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).
No, in-patient stay is not a requirement to receive home health care. In fact, many of our patients are referred by their personal physicians after their out-patient or follow-up visits.
Yes. Pristine Care Home Health Services, Inc. is accredited by The Joint Commission (one of the premier and established accrediting bodies), and member of California Association for Health Services at Home, as well as member of Home Health Quality Improvement national campaign. We check competency, criminal background, license verification, and medical history/physical exam (to make sure he/she is free of communicable disease) for each field clinician that we send to your place of residence.
Please call our Grievance coordinator, the Director of Patient Care Services, at 951-506-0348 immediately or send an e-mail to firstname.lastname@example.org and we will help resolve the issue within 48 hours.
If you feel that you or a loved one may benefit from home health, CONTACT US. A member of our experienced staff can work with you and your physician to determine if home health is right for you.
FOR REFERRAL SOURCES
Please fill out our “Quick Referral Form” and send back to us by fax or e-mail within 24 hours of referral date. By federal and state regulations, we need to perform an initial assessment of the patient’s needs for home health services and coordinate the initial assessment with you within 48 hours of referral date or physician-ordered start of care date.
Please review the “How to Bill Medicare for All Home Health Eligible Claims” and the “Physician’s Guide to Care Plan Oversight and Medicare Billing”. Use the” Care Plan Oversight (CPO) Log for Medicare Billing” to monitor the care plans of your patients. If you need further assistance with the CPO, please CONTACT US and ask for our billing department.
Yes. The following are basic requirements:
- The patient is an eligible Medicare beneficiary and Medicare is the appropriate payer (once our referral coordinator receives the patient information including the insurance information, we will check the eligibility for your patient and notify you if Medicare will pay for the services);
- You (the certifying physician), or a qualified non-physician practitioner (NPP, such as nurse practitioner or physician assistant) working in conjunction with you, or a physician who cared for the patient in an acute or post-acute facility directly prior to being admitted to home health, must have a face-to-face encounter with your patient within 90 days before start of care or within 30 days after start of care. Only you can certify that such encounter has occurred.
- You must establish a care plan for your patient, periodically review the care plan and update your orders as deemed necessary, and supervise our clinicians in providing home health care according to the care plan
- You must certify that your patient is confined to his/her home, and requires intermittent, medically necessary, and reasonable home health services (skilled nursing and/or physical therapy, occupational therapy, and speech therapy).
For your guidance, please refer to “Medicare Home Health Benefit Policy Manual”.
Yes. Please fill out the “Quick Referral Form” and send back to us by fax or e-mail. Our referral coordinator will get back to you within 24 hours and let you know if we can take the patient.