Medicare 101 for Home Care Professionals

Agencies participating in the Medicare Home Health Program need to educate professional staff on how to comply with Medicare's Conditions of Participation. Additionally, paraprofessional staff should have a general understanding of Medicare requirements related to homebound status, so they can notify their employer of any concerns that may affect Medicare eligibility. Failure to comply with Medicare requirements may result in survey deficiencies, loss of Medicare reimbursement, and penalties with far-reaching consequences. This program is an introductory course for professional staff working with Medicare clients.

This is a self-paced course with optional knowledge check quizzes after each lesson. These non-graded quizzes allow you to check your understanding of the lesson objectives before proceeding to the next lesson. After the final lesson you will be required to take the final exam. You must score 80% or higher to pass the course and obtain a certificate of completion.

  • Outline the basic history of Medicare.
  • Understand basic Medicare coverage.
  • Identify Medicare's expectations of home health providers and clinicians for reimbursement and compliance.
  • State the provider's responsibility with home care services.
  • Recognize the physician's responsibility related to home care services.
  • Define part-time/intermittent services.
  • Record requirements for daily skilled nursing visits.
  • List key components to document medically reasonable and necessary services.
  • Recognize the importance of documentation to support homebound status.
  • Identify when to decrease or increase visit frequency under Medicare.
  • Appropriately document the provision of skilled nursing services according to Medicare requirements.
  • Recognize the requirements for "homebound".
  • Learn to document a clear picture of the homebound status of Medicare clients.
  • Document appropriately to demonstrate that skilled services are reasonable and necessary.
  • Explain the criteria needed to meet Medicare's definition of reasonable and necessary home health aide services.
  • List the home health aide's responsibility in home care.
  • Describe Medicare's expectations regarding supervision for the home health aide (HHA).
  • Recognize basic legal requirements of home care documentation.
  • Identify basic requirements for Medicare coverage.
  • Recognize the requirements for "homebound".
  • Learn to document a clear picture of the homebound status of Medicare clients.
  • Identify Face-to-Face Requirements.
  • Identify Therapy Assessment Time Points.
Contact Time

2 contact hour(s) based on 60 minute contact hour

Estimated Time

The estimated time for completion for this activity is 2 hours

Intended Audience

This continuing education course is of interest for all healthcare professionals that communicate with patients and peers, such as: licensed practical nurses, registered nurse, physical therapists, dietitians, and social workers.

Course Planning Team

Kathy Richie, BSN, RN, Patricia Jump, RN, PHN, MA, Peggy Harris, BS, MS

Course Expiration Date

As required by ANCC, this continuing nursing education activity must carry an expiration date. You must complete the content, Final Quiz and Course Survey on or before that day. The last day to successfully complete this course and receive a Certificate of Completion will be December 31, 2019.

WNA/CEAP - Wisconsin Nurses Association
"Rochester Community and Technical College is an approved provider of continuing nursing education by the Wisconsin Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation."
Provider Approval Number 0149-006;
Disclosure Statements:

Commercial Support: This course was developed in accordance with ANCC Commercial Support Guidelines. No commercial support was accepted for the development of this course.

Non-endorsement of Products and Off Label Use: This course provides a balanced view of therapeutic options. Use of generic names is always considered before using trade names. Consequently, if trade names are necessary, when available, we will use trade names from several companies. RCTC and the course planning team do not endorsed any products or drugs that may be mentioned in this course.

Author Originating

Patricia Jump - RN PHN MA

Technical Nurse Consultant, President Acorn's End Training and Consulting. Patricia Jump received her Bachelor's in Nursing Degree from Winona State University and her Masters of Arts Degree in Health and Human Services Administration from St. Mary's University. She has over 25 years experience in the health care field and almost two decades of public speaking experience. As a professional trainer and consultant, Patricia conducts seminars across the country for all levels of employees in business, professional associations, educational organizations, churches, and government agencies. Additionally, she serves as personal coach, consultant, and retreat facilitator for home care leaders and organizations throughout the nation.


Materials used in connection with this course may be subject to copyright protection. Retention of the materials for longer than the class term, unauthorized further dissemination of the materials, or use of copyrighted materials in any way other than intended for this class is prohibited by Copyright and Teach Act laws.


This course was developed with Rochester Community and Technical College's Continuing Education and Workforce Development Division located in Rochester Minnesota. Development was funded from the Minnesota State Colleges and Universities System.

Course Code
Course Category
Professional Health