Re: Nursing home patients seen at outpatient facility

[Guest guest]

This is a very good question. I have had two nursing homes request them same

thing. I have a contract with them for evaluations when needed. As for billing

Medicare, The PT that worked at the hospital before I did tried that and I

still have the denial on file. Something about not being able to bill a NH

patient as OP. As for the advise from our business office. We can not bill

Medicare for NH patients.

I would like to know if anyone else has more information about this.

Kelley Finley, PT

maxeiner@... wrote:

> Our facility (outpatient hospital based Physical medicine) has experienced

> several patients from one specific nursing home being sent to us for PT

> evals and treatment. We have contacted the nursing home and they no longer

> have a PT on staff and do not plan to replace this position. Under the BBA

> should we be billing Medicare or the nursing home?

>

> Any information would be greatly appreciated.

>

> Thanks in advance.

>

> Amy Maxeiner,PT

> Manager Ambulatory Rehab Therapy Services

> Rockford, IL

>

> ------------------------------------------------------------------------

>

[Guest guest]

If your facility is separate from the SNF then you would bill Medicare B.

Jane Klugman

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[Guest guest]

Another thought, because you are located in a hospital, the patients will not

be subjected to the $1500.00 cap.

Jane

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[Guest guest]

In a message dated 3/5/1999 7:45:21 AM Eastern Standard Time,

JLKlugman@... writes:

<< Another thought, because you are located in a hospital, the patients will

not

be subjected to the $1500.00 cap.

>>

Nursing home Part B therapy patients are subject to the cap NO MATTER where

the service is provided. The nursing home, per HCFA dictate, is responsible

for tracking the cap. Please don't confuse this issue with the interim issues

regarding per provider cap (until HCFA transitions to per Beneficiary cap)

that Rehab Agencies and CORFs that report to Fiscal Intermediaries are subject

to, or the hospital " no-cap " issue. Any advice offered to the patient

(family) and waiver that they are required to sign at your facility should be

designed with a full understanding of the regulations.

As an FYI, both the National Association of Rehabiltiation Agencies (NARA) and

the American Medical Rehabiltiation Providers Association (AMRPA) have kept

their members updated with frequent faxes on these issues. Both of these

organizations lobby on behalf of all in the field, yet only a small percentage

are dues paying members. Our trade associations really need our help!!!

Regards

Beckley

Bloomingdale Consulting Group, Inc.

bcgbeckley@...

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[Guest guest]

Thank you for correcting me.

Jane Klugman

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[Guest guest]

Right now, if the patients are Part A SNF patients, you bill the SNF and

the SNF is paid through its prospective payment. If it is a Part B

patient, you can still bill Medicare directly as consolidated billing

for Part B has not yet gone into effect.

J. Kapusta, J.D. LL.M.

The Murer Group

Joliet, IL

tkapusta@...

> Nursing home patients seen at outpatient facility

>

>Our facility (outpatient hospital based Physical medicine) has

>experienced

>several patients from one specific nursing home being sent to us for PT

>

>evals and treatment. We have contacted the nursing home and they no

>longer

>have a PT on staff and do not plan to replace this position. Under the

>BBA

>should we be billing Medicare or the nursing home?

>

>Any information would be greatly appreciated.

>

>Thanks in advance.

>

>Amy Maxeiner,PT

>Manager Ambulatory Rehab Therapy Services

>Rockford, IL

>

>

>------------------------------------------------------------------------

>

>

[Guest guest]

If the patient is in a Part A bed -- you can't bill for Part B services even

if the services are provided at the hospital. The SNF is responsible for those

charges. There is a list of services which are exempt from this rule. They

were in our Dec 98 Part A bulletin -- no rehab services were included

Carolyn Gum

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[Guest guest]

Under PPS, all ancillary services, including rehab, are paid for in an

all-inclusive manner. The facility gets a dollar amount per day, and then

must provide all necessary services to the patient. If the SNF choses to

send their patients to the outpatient department at the hospital, the SNF

must pay the hospital to provide the services. If the SNF resident is not

under Part A services, but is covered under Part B, the rehabilitation

services Still must be billed by the SNF, regardless of who,or where, the

rehab services are provided. I think there is confusion due to the fact

that consolidated billing has been delayed. Consolidated billing requires

the SNF to bill for all Part B services, such as rehab,pharmacy, labs, etc.

Although the consolidated billing is on hold, Rehab was excluded from

this, and must be billed by the SNF. In other words, any rehabilitation

services, regardless of where provided, or who provides the service, must

be billed under the SNF provider number. If these services are provided by

Part B, they are then subject to the $1500 cap as well!!!

Hope this helps!

Kisiday

StrongerDay Rehab Co

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