HI 00601.450 Counting Visits Under the Hospital and Medical Plans

The number of visits are counted in the same manner under both the hospital and medical insurance plans.

A. Visit defined

A visit is a personal contact in the place of residence of a patient made for the purpose of providing a covered service by a health worker on the staff of the HHA, by others under contract or arrangement with the HHA, or a visit by a patient on an outpatient basis to a hospital, SNF, or rehabilitation center, or outpatient department affiliated with a medical school when arrangements have been made by the HHA for one or more covered services.

HHA's are required to have written policies concerning the acceptance of patients which include, consideration of the physical facilities available in the patient's home, attitudes of family members, and availability of family members to help in the care of the patient.

When personnel of the agency make such an initial evaluation visit, the cost is not chargeable as a visit since at this point the patient has not been accepted for home care. If, however, during the course of the initial visit, the patient is determined to be suitable for home health care by the agency, and is also furnished a skilled service as ordered under the physician's plan of treatment, this visit would become the first billable visit.

Evaluation visits may be made by a nurse to determine the specific personal care needs of the patient which will be assigned to a home health aide or to review the manner in which the personal care needs of the patient are being met by the aide. Such visits are also considered an administrative function and are not chargeable to the patient as skilled nursing visits.

If in the course of carrying out a home health plan of treatment for a patient, a nurse visits the patient for the purpose of evaluating the continuing skilled nursing needs of the patient or to teach and counsel the patient and family members regarding the nursing care needs and related problems of the patient at home, the visit would be chargeable as a skilled nursing visit.

B. Counting visits

If a visit is made simultaneously by two or more persons from the HHA to provide a single service, for which one person supervises or instructs the other, it is counted as one visit. If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit. If a visit is made by two or more persons from the HHA for the purpose of providing separate and distinct types of services, each is recorded—i.e., two or more visits. If the patient is taken elsewhere for the service because the service would not be furnished in his residence, one visit is counted for each service he receives.


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HI 00601.450 - Counting Visits Under the Hospital and Medical Plans - 05/09/2014
Batch run: 05/09/2014
Rev:05/09/2014