Guest guest Posted September 8, 2006 Report Share Posted September 8, 2006 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2006 Report Share Posted September 8, 2006 Leanora, You can provide the service as long as you are a licensed therapist. I think the question is...is it reimbursable. Under Medicare: It is my understanding of Home Health in this area, that any outpatient services provided while a patient is receiving HH services must be covered as a service under the HH dept. I am sure you can outsource this, but is hard to make it without losing money. We have done this on ocassion, although we must bill the HH dept. directly and they pay for the service out of their cost structure for taking care of the patient. I am not sure if HH is reimbursed per discharge, admission, etc. but the outpatient service is seen as a cost at that point. I would imagine need for service increases the reimbursement rate under the medicare system, but not that much. Help me out here all of you HH PT's. Maybe you want to talk with a local HH dept. and see if they have a need for services, can you contract with them at a rate that covers your costs plus some profit. The HH agency would then pay you directly. This is one option. Matt Dvorak, PT ________________________________ From: PTManager on behalf of leanora premeau Sent: Fri 9/8/2006 10:13 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2006 Report Share Posted September 10, 2006 Leanora, Hi, This has happened to me, only once. The pt said they were done with HH, but the HHA did not d/c the pt until the approved period was up. Since the HHA was within thier rights to not officially d/c the pt until the 60 days were up, I was at fault...and had to pay Medicare back the amount they reimbursed for PT. I contacted the HHA and told them I provided the services, and that they did not provide the in home services (as the pt. was obviously not homebound anymore), but the HHA pretty much said too bad. They were within thier rights and I should have checked with the HHA to see the exact date the pt was d/c's BEFORE providing OP PT. I do that now. Good luck. Amy Babb, DPT HSPT Florida 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. > > [Non-text portions of this message have been > removed] > > > > > > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > > Sick of working for someone else? > Tired of fighting against POPTS? > Ready to quit the corporate nonsense of large > organizations? > Visit www.InHomeRehab.com. > > PTManager encourages participation in your > professional association. Join > APTA, AOTA or ASHA and participate now! > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2006 Report Share Posted September 10, 2006 Dear Rick, What type of action will the medicare contractor take in reguards to the PT that provided the out patient services at home? Will they take a diciplinary action or suspend the license or some other action? If it was an honest mistake and they repay the contractor timely what will happen? Thanks, Leanora Rick Gawenda wrote: Leanora, Once the HHA submits their claim and it is paid, the Medicare contractor will recoup the payment to the PT for outpatient services. Rick Gawenda, PT HPA Government Affairs & Practice Committee --- leanora premeau wrote: > 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 - > > 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. > > [Non-text portions of this message have been > removed] > > > > > > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > > Sick of working for someone else? > Tired of fighting against POPTS? > Ready to quit the corporate nonsense of large > organizations? > Visit www.InHomeRehab.com. > > PTManager encourages participation in your > professional association. Join > APTA, AOTA or ASHA and participate now! > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2006 Report Share Posted September 10, 2006 Leanora, There is no disciplinary action. They will just take the money back. This happens more than you or others think. Rick Gawenda, PT --- leanora premeau wrote: > Dear Rick, > What type of action will the medicare > contractor take in reguards to the PT that provided > the out patient services at home? Will they take a > diciplinary action or suspend the license or some > other action? If it was an honest mistake and they > repay the contractor timely what will happen? > Thanks, Leanora > > Rick Gawenda wrote: > Leanora, > > Once the HHA submits their claim and it is paid, the > Medicare contractor will recoup the payment to the > PT > for outpatient services. > > Rick Gawenda, PT > HPA Government Affairs & Practice Committee > > --- leanora premeau wrote: > > > 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 - > > > > 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. > > > > [Non-text portions of this message have been > > removed] > > > > > > > > > > > > > > Please identify yourself, your discipline and your > > location in all messages > > to PTManager. > > > > Sick of working for someone else? > > Tired of fighting against POPTS? > > Ready to quit the corporate nonsense of large > > organizations? > > Visit www.InHomeRehab.com. > > > > PTManager encourages participation in your > > professional association. Join > > APTA, AOTA or ASHA and participate now! > > > > Please identify yourself, your discipline and your > > location in all messages > > to PTManager. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2006 Report Share Posted September 11, 2006 Leonora, As long as you pay back the amount owed, no action will be taken based on our experience. I would recommend the following as part of your procedures: Upon acceptance of any Medicare referral 1) Call the Medicare Contractor for your state to verify the patient is not currently under a home health agency; this is not always accurate, however, as computer files with the Contractor may not be current; 2) Question the patient if they have received any home health services recently; and I repeat, any! Many patients only remember they had an aide or a nurse coming out to see them and have never made the connection that it is actually a HHA providing care. 3) If there is any indication that a HHA was/is present, find out the agency name and call them to find out if or when the patient will be discharged. Most agencies are willing to tell you this information regardless of HIPAA implications. 4) Lastly, once you are in the home, keep your eyes open for HHA literature or other professionals coming out to see the patient. At least if 1-3 fail, you still might catch something and only lose on 1-2 visits vs. 12 visits. I hope this helps. Interestingly, you may still be entitled to collecting the 20% not paid by Medicare depending on how your wording of financial responsibility is stated. This I am not sure of, but I believe that when Medicare denies payment for a service, you can still collect the 20% from the patient if you had the patient sign an ABN. This is how Anodyne still gets paid for distributing their home units to patients. It might apply to your situation as well. , PT Florida 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. > > [Non-text portions of this message have been > removed] > > > > > > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > > Sick of working for someone else? > Tired of fighting against POPTS? > Ready to quit the corporate nonsense of large > organizations? > Visit www.InHomeRehab.com. > > PTManager encourages participation in your > professional association. Join > APTA, AOTA or ASHA and participate now! > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2006 Report Share Posted September 11, 2006 Group, What if the patient is still under Part A (homehealth) but is no longer home bound and still receiving nursing in the home and PT in a outpatient clinic? Regardless of the cert. period the homehealth company should DC the patient from services...correct? Is there a way to appeal this with medicare to get reimbursed under part B for the outpatient services since the patient should have been DC'd from home care for not being home bound? (Example homehealth PT and nursing after a TKA, PT x 4 weeks then the patient transitions to an outpatient facility but nursing coninues to draw blood everyother week. The nurse knew the patient was leaving the home to drive 17 miles for outpatient PT as well getting out for normal activities). Am I wrong in thinking that the patient should have been DC'd earlier than the end of the cert. period? Moss MPT, COMT MOSS Rehabilitation Center Springtown, TX 76082 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. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2006 Report Share Posted September 12, 2006 Dear Amy, Thanks for the reply.....How long after the services were rendered did you have to pay medicare back? Will they work with you if it is a large amount? How long after the HHA is out and the billing has been sent for HH does medicare see this as an overpayment? Thanks, Leanora, Colorado amymcbreenpt@... wrote: Leanora, Hi, This has happened to me, only once. The pt said they were done with HH, but the HHA did not d/c the pt until the approved period was up. Since the HHA was within thier rights to not officially d/c the pt until the 60 days were up, I was at fault...and had to pay Medicare back the amount they reimbursed for PT. I contacted the HHA and told them I provided the services, and that they did not provide the in home services (as the pt. was obviously not homebound anymore), but the HHA pretty much said too bad. They were within thier rights and I should have checked with the HHA to see the exact date the pt was d/c's BEFORE providing OP PT. I do that now. Good luck. Amy Babb, DPT HSPT Florida 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. > > [Non-text portions of this message have been > removed] > > > > > > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > > Sick of working for someone else? > Tired of fighting against POPTS? > Ready to quit the corporate nonsense of large > organizations? > Visit www.InHomeRehab.com. > > PTManager encourages participation in your > professional association. Join > APTA, AOTA or ASHA and participate now! > > Please identify yourself, your discipline and your > location in all messages > to PTManager. > Quote Link to comment Share on other sites More sharing options...
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