Medicare requires both prongs: the patient needs the aid of a supportive device or another person or has a condition that makes leaving home medically contraindicated, and leaving home requires a considerable and taxing effort. Document patient-specific evidence when homebound status is assessed, and ensure the longitudinal record continues to support both Medicare homebound criteria.
Evidence from this system that supports homebound status
A lack of support combined with the medical condition that requires assistance for the patient to leave home safely.
A caregiver-dependent situation in which leaving home requires arrangement and assistance.
A social or resource barrier (for example no transportation) that, with the condition, limits leaving home.
The considerable and taxing effort required to leave home given the combined medical and social limitations.
Homebound paragraph — example
Patient remains homebound. The medical condition combined with limited support means the patient requires the assistance of another person to leave home safely, and leaving requires arrangement and considerable effort; the patient cannot manage the demands of an outing independently. Leaving home therefore requires a considerable and taxing effort.
