Can a patient on home health skilled care also participate in outpatient cardiac rehab?

CMS Guidance on Simultaneous Home Health and Outpatient Cardiac Rehabilitation

1. Eligibility and Homebound Status:

- Patients must meet Medicare homebound criteria but can leave home occasionally for medical treatment, 

2. Coverage Rules:

- Home Health: Covered under Part A/B via Home Health Prospective Payment System (HH PPS).

- Cardiac Rehab: Covered under Part B outpatient benefit; must occur in hospital outpatient or physician     

3. Billing Rules:

- Home Health billed under HH PPS (PDGM model).

- Cardiac Rehab billed separately under Part B using CPT codes (e.g., 93797, 93798).

- Cardiac rehab is NOT bundled into home health consolidated billing.

4. Compliance Points:

- No duplicative services.

- Separate physician orders and care plans.

- Documentation must justify distinct goals and settings.

5. Patient Costs:

- Home Health: Usually no copay.

- Cardiac Rehab: 20% coinsurance under Part B + deductible.

Bottom Line:

Patients can receive both services simultaneously if homebound criteria remain met and services are distinct.