Medicare Guidelines

Front 1

Part A Medicare

Back 1

Pays for hospital, inpatient, SNF, home health, and hospice care.
*Part A is automatically provided to all who are covered by the Social Security system.
*Part A services have specific time limits and also require deductible and coinsurance payments by the beneficiary.

Front 2

Part B Medicare

Back 2

Pays for hospice outpatient physician and other professional services including OT services provided by independent practitioners.
*Part B considered supplemental medical insurance program and therefore must be purchased by the beneficiary, usually as a monthly premium.
*Part B has no time limit and requires 20% copayment.

Front 3

Criteria for Medicare coverage of OT

Back 3

1. Prescribed by a physician
2. Performed by a qualified OT or an OTA
3. Service is reasonable and necessary for treatment of individual's injury or illness
4. There are no diagnostic restrictions for coverage
5. OT must show improvement

Front 4

Difference between Part A and Part B

Back 4

The frequency in which the individual receives services. Inpatient A coverage requires services for a minimum

Front 5

Medicare Does not cover. . .

Back 5

Chronic illness, long term supportive care, or all medical expenses incurred when ill.

Front 6

OT in home care. . .

Back 6

Covered if the individual is homebound and needed intermittent skilled nursing care, PT, or ST before OT began.
*Homebound Status criteria includes. . .
Confined to home dut to the need for the aid of ambulatory devices, the assistance of others, or specail transportation.
*Person may leave home if for an appointment