Re: Outpatient PT Services in the home

[Guest guest]

I would also like to know what the consensus is regarding this issue, as this

has also come up at our facility, with much debate.

Maureen Meyeres

mmeyeres@...

[Guest guest]

In a message dated 5/16/00 6:22:58 AM Eastern Daylight Time, mmeyeres@...

writes:

<< ptmanageregroups >>

Why can't you treat a person in the home if you chose to make that the

setting of treatment. Maybe I should ask what the debate is. If the debate

is the correct coding then at minimum can't you charge for the visit as if it

was done in the clinic. It seems to me to be more of a business decision

(costs) then an ethical one if coding is done properly. It is a matter of

customer service or is it a regulatory matter that can be overcome by proper

coding?

Jeff Hathaway, PT, CEC

Primary Physical Therapy

[Guest guest]

I answered the individual directly who asked this question, but thought I would put my 2 cents in here as well. I can only speak from experience and alas cannot refer to a specific regulation, although referring to JCAHO would be a good idea. When we had our JCAHO review, it was made quite clear to us that in order to provide therapy in the home, you had to be licensed to do so. I may be missing the boat on this question, but it was never clarified in this case that there is a license to do home based therapy. We were ok doing home safety evaluations, but these are only one time visits and do not incorporate any treatment, just recommendations. Fortunately, this is what we had been doing. Even with that, we were not in compliance with areas such as infection control. The JCAHO reviewer stated that we needed to have a traveling " bag " that included CPR mask, towels, soap to wash hands etc.(do you know that one is not supposed to use the linen in the home to wash their hands?) Questions related to how we disinfected any equipment we used were brought up. There is a litany of regulations pertaining specifically to home therapy. So my obvious recommendations are that if you are not licensed to perform home therapy, don't do anymore than safety evals and even with that make sure you are in compliance with JCAHO standards. It does put those who are not " homebound " , but do not want to or cannot come in for therapy in a catch 22 position.

Mike Hampton, P.T.

Outpatient Therapy Manager

Rehabilitation Services

St. ph Hospital

Bellingham, WA

Re: Outpatient PT Services in the home

In a message dated 5/16/00 6:22:58 AM Eastern Daylight Time, mmeyeres@...

writes:

<< ptmanageregroups >>

Why can't you treat a person in the home if you chose to make that the

setting of treatment. Maybe I should ask what the debate is. If the debate

is the correct coding then at minimum can't you charge for the visit as if it

was done in the clinic. It seems to me to be more of a business decision

(costs) then an ethical one if coding is done properly. It is a matter of

customer service or is it a regulatory matter that can be overcome by proper

coding?

Jeff Hathaway, PT, CEC

Primary Physical Therapy

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today.

LAMP Summit 2000. July 23-25, 2000 Register at .

[Guest guest]

Let's remember that we need facts - not opinions - in matters of coding

and reimbursement where there is potential for compliance

violations.

At 06:50 PM 5/16/00 -0400, you wrote:

In a message dated 5/16/00 6:22:58 AM Eastern

Daylight Time, mmeyeres@...

writes:

<< ptmanageregroups >>

Why can't you treat a person in the home if you chose to make that the

setting of treatment. Maybe I should ask what the debate is.

If the debate

is the correct coding then at minimum can't you charge for the visit as

if it

was done in the clinic. It seems to me to be more of a business

decision

(costs) then an ethical one if coding is done properly. It is a

matter of

customer service or is it a regulatory matter that can be overcome by

proper

coding?

Jeff Hathaway, PT, CEC

Primary Physical Therapy

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

LAMP Summit 2000. July 23-25, 2000 Register at .

R. Kovacek, MSA, PT

Email Pkovacek@...

313 884-8920

Visit

<www.PTManager.com>

TOGETHER WE CAN MAKE A DIFFERENCE !

[Guest guest]

Well, here’s a little more fact and

a little more opinion.  This was sent

directly to Mr. Hathaway, but for the group’s consumption:

From the Medicare Coverage of Services

Manual:

270.4

“Outpatient Requirement—PT, OT, and SP

services are covered when furnished by a provider to its outpatients, i.e., to

patients in their homes, to patients who come to the facility’s outpatient

department, or to inpatients of other health facilities.”

I cannot find the reference, but somewhere

there is language stating that only therapy time may be charged, not travel

etc.  So, these types of visits are

economically not feasible as a rule, but as a part of a plan of care may make

sense to perform in special circumstances.

Bob Perlson

Director,

Asante Rehabilitation Services

Medford

OR

-----Original

Message-----

From: Kovacek

Sent: Tuesday, May 16, 2000 4:26

PM

To: ptmanageregroups

Subject: Re:

Outpatient PT Services in the home

Let's

remember that we need facts - not opinions - in matters of coding and

reimbursement where there is potential for compliance violations.

At 06:50 PM 5/16/00 -0400, you wrote:

In a message dated 5/16/00 6:22:58 AM

Eastern Daylight Time, mmeyeres@...

writes:

<< ptmanageregroups >>

Why can't you treat a person in the home if you chose to make that the

setting of treatment. Maybe I should ask what the debate is. If the

debate

is the correct coding then at minimum can't you charge for the visit as if it

was done in the clinic. It seems to me to be more of a business decision

(costs) then an ethical one if coding is done properly. It is a matter of

customer service or is it a regulatory matter that can be overcome by proper

coding?

Jeff Hathaway, PT, CEC

Primary Physical Therapy

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

LAMP Summit 2000. July 23-25, 2000 Register at .

R. Kovacek, MSA, PT

Email Pkovacek@...

313 884-8920

Visit <www.PTManager.com>

TOGETHER WE CAN MAKE A DIFFERENCE !

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

LAMP Summit 2000. July 23-25, 2000 Register at .

[Guest guest]

Well, I wish I had more specific cited references for you all. But for

what it is worth here is my two cents. Opinion:

JCAHO is not a licensing or regulatory body. They can not tell us what

to do or not to do. Sometimes I think the provider community doesn't stand

up enough to JCAHO when they are perceived to become too expansive in their

mission. We also need to keep in mind that complying with, or not complying

with, JCAHO does not mean we are complying with, or not complying, with

the other authorities which govern practice. Sorry for the short soap box

and I've wondered off of 's response.

There are numerous issues to consider. How is the hospital licensed?

Are there restrictions on that license regarding home care? Does the hospital

need to have a separate license for home care? What 3rd party payor(s)

are we talking about? Medicare? Medicaid, Private? Self pay? etc. How will

this be billed? Are the expenses for the PTs being "cost out" to an expense

report for another payor or govt. body for services that are supposed to

occur and have the overhead of the hospital? etc. etc.

Most hospitals use the UB92 form. The HCFA 1500 form has a place of

service code so you can indicate where the service occurred. Depending

on the answers to the above indicating the POS on the bill would seem to

be important for most 3rd party payors.

My understanding of the Medicare "homebound" situation is that it applies

to the patient and where the service occurs and not the type of provider.

In other words, I am a PTPP provider for Medicare. I can treat patients

in the home if they meet the definition of home bound. I have to treat

them in my office if they are not "home bound."

Sorry if I added more questions than answers.

"Hampton, " wrote:

I answered the individual directly who asked this question,

but thought I would put my 2 cents in here as well. I can only speak from

experience and alas cannot refer to a specific regulation, although referring

to JCAHO would be a good idea. When we had our JCAHO review, it was

made quite clear to us that in order to provide therapy in the home, you

had to be licensed to do so. I may be missing the boat on this question,

but it was never clarified in this case that there is a license to do home

based therapy. We were ok doing home safety evaluations, but these are

only one time visits and do not incorporate any treatment, just recommendations.

Fortunately, this is what we had been doing. Even with that, we were not

in compliance with areas such as infection control. The JCAHO reviewer

stated that we needed to have a traveling "bag" that included CPR mask,

towels, soap to wash hands etc.(do you know that one is not supposed to

use the linen in the home to wash their hands?) Questions related to how

we disinfected any equipment we used were brought up. There is a litany

of regulations pertaining specifically to home therapy. So my obvious recommendations

are that if you are not licensed to perform home therapy, don't do anymore

than safety evals and even with that make sure you are in compliance with

JCAHO standards. It does put those who are not "homebound", but do not

want to or cannot come in for therapy in a catch 22 position.

Mike Hampton, P.T.

Outpatient Therapy Manager

Rehabilitation Services

St. ph Hospital

Bellingham, WA

Re: Outpatient PT Services in the

home

In a message dated 5/16/00 6:22:58 AM Eastern Daylight

Time, mmeyeres@...

writes:

<< ptmanageregroups >>

Why can't you treat a person in the home if you chose

to make that the

setting of treatment. Maybe I should ask what the

debate is. If the debate

is the correct coding then at minimum can't you charge

for the visit as if it

was done in the clinic. It seems to me to be more

of a business decision

(costs) then an ethical one if coding is done properly.

It is a matter of

customer service or is it a regulatory matter that can

be overcome by proper

coding?

Jeff Hathaway, PT, CEC

Primary Physical Therapy

Coming September 22,2000 - Helene Fearon on Coding and

Reimbursement - Rochester Michigan. Register at today.

LAMP Summit 2000. July 23-25, 2000 Register at .

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement

- Rochester Michigan. Register at today.

LAMP Summit 2000. July 23-25, 2000 Register at .

--

*******************************************************

M. White, PT, OCS

Physical Therapist, Consultant

191 Blue Hills Parkway

Milton, MA USA 02186

P:

White@...

http://members.tripod.com/White/

[Guest guest]

Probably Dave would be the best to answer this question - but I thought that you had to be a licensed provider (agency) in order to provide services in the home under Medicare - meaning that you are able to provide the entire gamut of services including nursing, home health aides, SLP, OT, PT and MSW. I believe that there is a way to bill under part B, but not exactly sure how to do it --- Dave?

Pike, PT, GCS

Brighton, Michigan

[Guest guest]

We are a SNF in Virginia. For years we have a had a Medicare certified HHA on

campus as well. Due to the increased red tape and lower demand in the past few

years we are planning to close that business in the next few months. Skilled

therapy visits are what have made up the bulk of the load anyway. In

researching our options to provide in-home therapy, I found the the following:

As a SNF we can only do in-home assessments as you indicated. If we want to

follow our discharges home with therapy services, at the very least, we must

secure Rehab Agency status (ORF certification). That status would allow us to go

into homes without having to provide the whole host of nursing, etc. We could

also opt for CORF status that also allows therapy services to be provided in

locations other than the CORF's physical location. We secured this information

from our State Department of Health Office. Hope this helps.

Tammy PT

Director of Rehab

Friendship Manor

Roanoke, VA

tkelly1@...

Re: Outpatient PT Services in the home

In a message dated 5/16/00 6:22:58 AM Eastern Daylight Time,

mmeyeres@...

writes:

<< ptmanageregroups >>

Why can't you treat a person in the home if you chose to make that the

setting of treatment. Maybe I should ask what the debate is. If the debate

is the correct coding then at minimum can't you charge for the visit as if

it

was done in the clinic. It seems to me to be more of a business decision

(costs) then an ethical one if coding is done properly. It is a matter of

customer service or is it a regulatory matter that can be overcome by proper

coding?

Jeff Hathaway, PT, CEC

Primary Physical Therapy

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

LAMP Summit 2000. July 23-25, 2000 Register at .

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