RE: Medicare B

September 8, 2006

market to the nurse case managers, carriers and employers and try to funnel

pts. to you that way. You may be able to get on the plans up front and offer

a volume discount or something like that. The paper for us is not a good

medium except for announcements or special printings. We focus on

employers,prevention. Employers tell the doctors where they want their pts. to

go for

therapy. We have lots of POPTS here and we hold our own with our approach.

Good

Luck. Sounds like a frustrating place to be in practice.

Bubba Klostermann OT, CVE, CEAS

CEO, WORK & REHAB

4546 South 14 th

Abilene, Texas 79605

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email: bubklo@...

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September 8, 2006

To answer your other question, I think the code is 12 on the HCFA for in

home therapy. The negative here is that the home health agencies are going to

be a big competitor here and then the doctors get marketed heavy by those

agencies.

Bubba Klostermann OT, CVE, CEAS

CEO, WORK & REHAB

4546 South 14 th

Abilene, Texas 79605

phone:

fax:

email: bubklo@...

This e-mail and any files transmitted with it are the property of WORK &

REHAB, are confidential, and are intended solely for the use of the

individual or entity to whom this e-mail is addressed. If you are not

one of the named recipient(s) or otherwise have reason to believe that

you have received this message in error, please notify the sender and

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e-mail is strictly prohibited.

September 8, 2006

Leanora,

You need to call the home health agency directly and ask them if the patient

is under a home health plan of care. If she is you cannot see her under part B

unless you do a consolidated billing contract with the home health agency. If

she is not under a home health plan of care, then you can see her under part B.

Odilia

leanora premeau wrote:

Hi,

This question is for anyone that provides out patient services in the home for

Medicare B beneficiaries. If a patient is still seeing a home health nurse one

time a week or two times a month and all other diciplines are out of the home,

Can a patient receive out patient services for physical therpay in the home?

Medicare B is billed for this. I am in the state of Colorado. Also, I am trying

to market a small out patient clinic and the competition is tough here. The

Dr.'s send all the clients to the PT's who rent from them across the hall and

there are so many wellness people here that claim they can treat injuries I want

to scream! I heard that a PT gave an inservice that earned Dr's CEU's and she

did this through the university where she graduated?? How does one go about

this?? I cannot get in to see Dr.'s as I waste time and never get in to talk to

them.....It is a tough go here and I need help with marketing. The newpaper

isn't helpin g at

all.......................Thanks, Leanora Premeau M.P.T.

---------------------------------

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September 8, 2006

Only 1 Medicare payor source can be billed at a time. Home Health is billed

under Medicare Part A, if the nurse is actively seeing the patient then that

case is open with Medicare Part A. If you then try to bill Medicare Part B

for outpatient PT you will be denied. If there is a physical therapy need

and nursing is still in the PT should be provided under the Medicare Part A

benefit.

Additionally, even after a patient is discharged from home health there may

be a lag time with the agency actually discharging the case in the computer.

Until they are closed completely with Home Health you will be denied with

billing. We always call the Home Health agency to insure they have

discharged the patient in the computer before picking them up for outpatient

services.

Debbie

Director of Rehab

Northwoods Lodge

_____

From: PTManager [mailto:PTManager ] On Behalf

Of leanora premeau

Sent: Friday, September 08, 2006 8:13 AM

To: PTManager

Subject: Medicare B

Hi,

This question is for anyone that provides out patient services in the home

for Medicare B beneficiaries. If a patient is still seeing a home health

nurse one time a week or two times a month and all other diciplines are out

of the home, Can a patient receive out patient services for physical therpay

in the home? Medicare B is billed for this. I am in the state of Colorado.

Also, I am trying to market a small out patient clinic and the competition

is tough here. The Dr.'s send all the clients to the PT's who rent from them

across the hall and there are so many wellness people here that claim they

can treat injuries I want to scream! I heard that a PT gave an inservice

that earned Dr's CEU's and she did this through the university where she

graduated?? How does one go about this?? I cannot get in to see Dr.'s as I

waste time and never get in to talk to them.....It is a tough go here and I

need help with marketing. The newpaper isn't helpin g at

all.......................Thanks, Leanora Premeau M.P.T.

---------------------------------

Talk is cheap. Use Yahoo! Messenger to make PC-to-Phone calls. Great rates

starting at 1¢/min.

September 8, 2006

Hello again, Leanora -

A home health agency admission is Part A, and is paid on a " case rate "

basis. That payment is to cover all services required during the 60 day

episode. Any services not offered by the agency must be purchased by the

agency. They generally refuse to do that. They never have do it if you ask

" after the fact " , and you lose.

If you're offering Part B, then your prospective patient must **not** still

be in a Part A 60-day episode. They must have been discharged completely

from the agency... AND they must have sent their bill. Now that you know

this, you might choose to never admit someone who's still in an episode of

Part A. You may want to ask the prospective patient whether they have had

ANYone do ANY services within the home during the past 60 days, and then

(try to) secure guarantee of payment.

Best wishes,

Dick Hillyer, PT, MBA,

W. Hillyer

700 El Dorado Pkwy West

Cape Coral, FL 33914

Home

Fax

Mobile

Medicare B

Hi,

This question is for anyone that provides out patient services in

the home for Medicare B beneficiaries. If a patient is still seeing a home

health nurse one time a week or two times a month and all other diciplines

are out of the home, Can a patient receive out patient services for physical

therpay in the home? Medicare B is billed for this. I am in the state of

Colorado. Also, I am trying to market a small out patient clinic and the

competition is tough here. The Dr.'s send all the clients to the PT's who

rent from them across the hall and there are so many wellness people here

that claim they can treat injuries I want to scream! I heard that a PT

gave an inservice that earned Dr's CEU's and she did this through the

university where she graduated?? How does one go about this?? I cannot

get in to see Dr.'s as I waste time and never get in to talk to them.....It

is a tough go here and I need help with marketing. The newpaper isn't

helpin g at

all.......................Thanks, Leanora Premeau M.P.T.

---------------------------------

Talk is cheap. Use Yahoo! Messenger to make PC-to-Phone calls. Great rates

starting at 1¢/min.

September 9, 2006

Hi Dick, Thanks for writing me back, I know of a case where the PT did not

know a nurse was still going into the home and the PT did not know. They saw

the patient two times a week for several weeks as a out patient, billing MedB.

He was recently discharged and the claims have all been paid. My friend is

pretty upset and I wonder what will happen??? The client told him everyone was

out of the home. The client is very lucid and I suppose he did not understand

the system or rules????????? What now?? Will the out patient PT have to pay

medicare back at some point? Thanks, Leanora

............

Dick Hillyer wrote: Hello again, Leanora -