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a1singer1965 Asked April 5, 2025

How to get an independent caregiver certified as a medicare provider?

I am trying to get medicare to pay some cost for a daily caregiver & they are saying the caregiver MUST work for an agency. Is this true?

97yroldmom Apr 6, 2025
Alsinger

If your mom is eligible for home health services through Medicare, not Medicaid, it would be under one of two circumstances. One circumstance, she has been in the hospital or rehab and a doctor orders home health until her wound heals or she recovers from the illness that caused her to seek treatment. That is covered under Part A of Medicare. This care consists of an RN to assess the care needed, Usually an LVN once a week, a CNA to provide personal care a few times a week for a bath and Physical or Occupational Therapist as ordered. All of these providers have multiple patients. They only spend 20 or 30 minutes per visit. Sometimes more, sometimes less. So even if you worked for them, you would have multiple patients and would need certification/license as your state dictates as an RN, LVN, CNA, etc. The CNA is the one requiring least training and the one spending the most time with each patient as a rule. So if you were a CNA and worked for a home health company you would be paid by the company, not Medicare and you would spend a short amount of time with your mom each visit, usually two or three times a week. Then you would be off to see your other patients.

Medicare also pays for patients who are considered home bound. This is covered by Part B. Both my mom and my DH aunt had home bound coverage for years. This doesn’t mean they are bed bound, just that they can’t easily leave home, usually have mobility issues, use a cane, walker etc., My mom didn’t use either when she began using home health.
The doctor has to order it and a nurse from the home health will do an assessment and determine what care is needed that they provide. Then every 6 weeks or so the RN will do a recertification to continue the care if appropriate.

Now all this I have described is under original Medicare not a Medicare Advantage plan. The Medicare Advantage plans called Part C, offer home health but the ones I have had any dealings with are totally different from original Medicare. Each Medicare Advantage Plan is different depending on geography and what the private insurer provides. My friends sister has an advantage plan and the nurses just made a phone call after an initial visit and provided no cna. But that could be totally different in your area. You have to check with your moms insurer if she has an advantage plan.

I just looked at the link JoAnn and MG provided and it appears to be the same that I am familiar with.

Ask your mom’s doctor to order home health for your mom. The services they provided were very helpful for my LOs and me as a long distance caregiver. If she has seen the doctor recently, you should be able to call and request over the phone.

If your click on the link provided on the site recommended, you can find the way to access the home health companies in your moms zip code. Call a few of them to discuss your mom’s situation and see what you learn. The company I worked with would fax the orders they needed to have signed to the doctor for approval.
The patient has to have seen the doctor or plans to see the doctor w/n a certain time frame to initiate coverage. I used Telemed visits and virtual visits to keep my LOs coverage going for years.

JoAnn29 Apr 6, 2025
Medicare does not pay for full-time aides. The one time they do pay is if a Dr orders "in home" care. That is usually for Physical Therapy, treating a wound, etc. Its temporary and an aide only comes out a couple times a week to bathe the client.

An independent aide cannot get Medicare certified, it doesn't work that way. Its usually a provider, like a doctor, hospital or clinic that applies. This way they can bill Medicare. It works the same for Medicaid. Where I live, our EMTs and ambulance squad can bill Medicare. But they use a billing company.

Here is what Medicare will do.

https://www.medicare.gov/coverage/home-health-services

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MG8522 Apr 5, 2025
Yes. From the Medicare website:

"A doctor or other health care provider (like a nurse practitioner) must assess you face-to-face before certifying that you need home health services. A doctor or other health care provider must order your care, and a Medicare-certified home health agency must provide it."

This lists all of the specifics:

https://www.medicare.gov/coverage/home-health-services

Geaton777 Apr 5, 2025
Do you mean Medicaid? If so, you need to call and talk to Medicaid in your home state, since Medicaid rules can vary by state.
a1singer1965 Apr 5, 2025
Its for Medicare...I dont think Mom is eligible for medicaid, too much in other assets

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