Continuous Home Care

Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch.9 §40.2.1)

Medicare Claims Processing Manual (CMS Pub. 100-4, Ch.11 §30.1)

Continuous home care is to be provided only during periods of crisis to maintain the beneficiary at home. Continuous care cannot be provided in a skilled nursing facility (SNF), inpatient hospital, inpatient hospice facility, a long term care hospital (LTCH), or an inpatient psychiatric facility.  A period of crisis is a period of time when the beneficiary requires the higher level of “continuous care” for at least 8 hours in a 24-hour period (midnight to midnight) to achieve palliation or management of acute medical symptoms.  The care does not have to be “continuous” to qualify, but must total eight hours or more of care within the 24 hour period.  The care can be provided by a RN, LPN and home health aide.  However, at least 50 percent of the total care provided must be provided by a nurse.

Please note that all nursing and home health aide services provided must be counted into the continuous care time. A hospice cannot choose to count fewer home health aide hours than were actually provided to get the percentage of nurse hours up to 50 percent. Doing so may be interpreted as an attempt to manipulate information to obtain higher payment, which could be viewed as a violation of the False Claims Act.

Examples of counting continuous care hours are as follow:

• If less than 8 hours of care was given or if death occurs before 8 hours, do not count the hours as continuous care; bill the day as a routine home care day.
• Medical social workers, counselors, pastoral care, and bereavement counseling by any staff member certainly may be appropriate and valuable in the home during a crisis; however, those hours may not be counted in the continuous care hours.
• If within a 24 hour period, 6 hours of care is provided by a home health aide, and 4 hours of care is provided by a skilled nurse, do not count the hours as continuous care since at least 50 percent of the total care provided was not provided by a nurse.
• Care that spans midnight, (e.g., 4 hours of skilled nursing care provided from 8:00 p.m.—12:00 a.m. and from 12:00 a.m.—4:00 a.m.), can not be counted as continuous care hours. 

 

Supportive Documentation for Continuous Home Care

When it is determined that a beneficiary meets the requirements for continuous home care, appropriate documentation must be available to support the requirement that the services provided were reasonable and necessary and were in compliance with an established plan of care in order to meet a particular crisis situation.

When a level of care changes, the medical record must show the date, time and reason why the level of care changed (e.g., Beneficiary in severe pain, caregiver unable to control. Continuous care began 1/1/YY at 8 a.m., Mary Nurse R.N.). A later entry may read, "beneficiary's pain is controlled and caregiver is able to care for beneficiary, routine care to begin 1/3/YY at 7 a.m." The 1/3/YY day must be billed as a routine care day, because the minimum of 8 hours is not met. Document the interventions and observations to support the need for each hour of continuous care billed.

The supportive documentation should show clearly the beneficiary’s condition warranting the interventions provided by the hospice staff at this higher level of care.  The documentation should then describe the beneficiary’s response to the care.

Although Continuous Home Care (CHC) is billed in 15 minute increments, the supportive documentation is not required to be every 15 minutes.  Supportive documentation should be as frequent as necessary to support continued CHC, and is suggested at least hourly.

Page last updated: June 29, 2010

• Doing Business with Cahaba
• Holiday Schedule
• Careers