“Home health” and “home care” get used interchangeably in conversation, but for payers and referral sources they’re different. Medicare-certified home health has a specific definition; non-medical home care doesn’t. Mixing them up can cost you contracts, trigger denials, and confuse discharge planners,who may send the next referral elsewhere if you can’t clearly say what you do.
Home health (Medicare-certified)
Skilled care,nursing, therapy, etc.,ordered by a physician, for a homebound patient, under a plan of care. Reimbursed by Medicare, Medicaid, and most insurers. Subject to Conditions of Participation (CoPs), OASIS, and state licensure as a home health agency. Referral sources (hospitals, SNFs, physicians) sending “home health” referrals usually mean this. Billing, documentation, and face-to-face rules all apply; you’re in the Medicare ecosystem.
Home care (non-medical)
Non-skilled: aides for ADLs, companionship, sometimes medication reminders. Often private pay or Medicaid waiver. Different state rules (sometimes “home care” or “personal care” license). Not the same as Medicare home health. No OASIS, no plan of care in the Medicare sense, and different payers. When a discharge planner says “they need home health,” they typically mean skilled; when a family says “we need someone to help at home,” they might mean either. Clarify before you promise the wrong thing.
Why it matters for contracts and intake
Hospital and SNF contracts usually specify “home health” (skilled). If your agency does both skilled and non-skilled, make sure your contract and your intake team know which service is being requested. Taking a “home health” referral and sending an aide without skilled need is a compliance and payment problem. Training intake and referral-development staff on the distinction reduces wrong referrals and keeps partner trust. A one-pager that’s always on hand,in the office and in the field,helps everyone use the terms correctly.
We have a one-pager you can download: side-by-side comparison (skilled vs non-skilled, payers, licensure, key terms) so you and your team use the language correctly with referral sources and families. Use the button below to get it.