Under CCN, skilled home health care includes skilled bundled, skilled unbundled and skilled expanded.
Skilled bundled care: Reimbursed via the Medicare Patient-Driven Groupings Model (PDGM), episodic method, clearly stated in the SEOC approved referral/authorization letter. It should be billed appropriately on a UB04.
Skilled unbundled care: Reimbursed on a fee-for-service basis and the VA issue orders regarding services and visits. The coding allowed is to accommodate billing per hour or per 15-minute increments. It should be billed appropriately on a CMS 1500.
Skilled expanded care: This is skilled private duty nursing for highly dependent Veterans. It will be reimbursed on a fee-for-service basis and VA will issue orders regarding services and visits/hours. The coding allowed is to accommodate billing per hour or per 15-minute increment. It should be billed appropriately on a CMS 1500.
For more specific information regarding home health care, refer to the Home Health Quick Reference Guide.
Homemaker, Home Health Aide or In-home Respite Care is available only through CCN. This care is included in the CCN Healthcare Benefit, and involves help with daily activities such as bathing, grooming, meal preparation and household tasks to enable independence and safety for the Veterans who are in need of it.
This care must be approved by VA, who chooses an appropriate SEOC. The SEOC indicates the number of hours the Veteran qualifies for per week. The specific amount of time that has been ordered by the VA physician is spelled out on the VA documentation.
For more specific information regarding unskilled home health care, refer to the Unskilled Home Health Quick Reference Guide.