Insurance & Billing

Medicare Home Health Requirements

Physician's Order

Your doctor, nurse practitioner, or physician assistant must certify that you need home health services and create or approve your plan of care. We work directly with your physician to make this seamless.

Homebound Status

You must be considered "homebound" — meaning leaving your home requires considerable effort due to your condition, illness, or disability. You do not have to be completely bedridden to qualify.

Skilled Need

You must need skilled nursing care, physical therapy, speech-language pathology, or occupational therapy. A skilled need is what opens the door to Medicare home health coverage.

Medicare-Certified Agency

You must use a Medicare-certified agency. We are Medicare-certified — so you are covered when you choose us.

Medicare Part A or B

Home health is covered under both Medicare Part A (if following a hospital or skilled nursing facility stay) and Medicare Part B (for ongoing home health needs). In most cases, your cost is $0.

The bottom line on Medicare home health:

If you meet the homebound and skilled-need criteria, and your physician certifies care, Medicare covers 100% of eligible home health services — including skilled nursing, physical therapy, occupational therapy, speech therapy, and home health aide services (when accompanying skilled care).
There is no cost to you.

Ohio Medicaid Home Health

Ohio Medicaid covers home health services for eligible members who meet medical necessity criteria. Like Medicare, Medicaid home health requires a physician’s order and a documented clinical need. Novela is enrolled with the Ohio Department of Medicaid and works with managed care plans (MCPs) to ensure your benefits are verified before services begin.

For patients who are dual-eligible (enrolled in both Medicare and Medicaid), Medicaid may cover costs that Medicare does not — reducing your out-of-pocket expenses to zero or near-zero. Our billing team will coordinate both coverages on your behalf.

Ohio DODD Waiver Coverage

Ohio’s Department of Developmental Disabilities (DODD) administers Home and Community-Based Services (HCBS) waivers that fund skilled nursing and other support services for individuals with intellectual and developmental disabilities. If you or your family member is enrolled in a DODD waiver program — such as the Individual Options (IO) Waiver or the Level One Waiver — Novela’s DODD nursing services may be covered.

Our team is experienced in navigating DODD authorizations, service agreements, and care coordination requirements. We work with your Support Services Administrator (SSA) to ensure services are approved and properly documented.

Private Pay Options

For patients and families who do not qualify for Medicare or Medicaid coverage — or who wish to supplement covered services — Novela Home Health offers private pay options at competitive, transparent rates. We will provide you with a clear quote before services begin, with no hidden fees or surprise charges. Contact us to discuss your situation and explore your options.

Frequently Asked Questions

No. While many patients begin home health following a hospital or skilled nursing facility stay, a prior hospitalization is not required for Medicare home health. You simply need a qualifying skilled need, homebound status, and a physician's order. Medicare Part B covers home health regardless of prior hospitalization.

Medicare defines homebound as a condition where leaving your home requires a considerable and taxing effort due to your illness, injury, or disability. You may still leave home occasionally for medical appointments, religious services, or brief outings — and still qualify as homebound. Our nurses can help assess your situation during the initial evaluation.

In most cases, yes. Medicare covers 100% of eligible home health services — skilled nursing, therapy, and home health aide services (when accompanying skilled care) — with no copay and no deductible for the home health benefit itself. There is no cost to you for services provided by a Medicare-certified agency, as long as you meet coverage criteria.

Simply call us at (614) 000-0000 or submit a request on our Contact page. Our care coordinator will speak with you, gather basic information, and then work with your physician and insurance to verify your benefits and obtain the necessary orders. We handle the paperwork — you focus on healing.

Once we receive a physician's order and verify your insurance, we typically schedule your initial nursing assessment within 48 hours. In urgent situations, we work to accommodate faster start times whenever clinically possible. We know that when you or your loved one needs care, waiting is not an option.

Absolutely. Under Medicare regulations, you have the right to choose your home health agency. You are not required to use the agency suggested by your hospital or discharge planner. If you prefer us, simply let your discharge team know — it is your right, and we will coordinate everything from there.

Yes. We are enrolled with the Ohio Department of Medicaid and work with Medicaid Managed Care Plans operating in Franklin County and surrounding areas. Our billing team will verify your specific plan coverage before services begin, so there are no surprises.

Home health care is flexible by design. If your condition improves and you need fewer visits, or worsens and requires more intensive support, your care plan is updated by your physician with our clinical team's input. We stay in close communication with your doctor throughout your episode of care — and we are never more than a phone call away if your situation changes unexpectedly.