Guest guest Posted April 24, 2008 Report Share Posted April 24, 2008 I agree with . I've had patient's family d/c the HH agency so that I can see them under Part B. There is NO requirement that I know of where a patient MUST be seen by HH versus in-home Part B. However, there are certain advantages/disadvantages to HH ~vs~ Part B and these are things that should be discussed with the patient/family. Ron -- Ron Carson MHS, OT Hope Therapy Services, LLC www.HopeTherapyServices.com ===============<Original Message>=============== On 4/24/2008, pkovacek@... said: PK> Tom PK> In your previous response your wrote: PK> " As far as I know, if a beneficiary meets the requirements for >> home health, then they must be seen by a home health certified PK> agency. You >> can't just bypass to Part B therapy if they meet the Part A PK> requirements. " PK> Please provide a reference for this " must " statement. My PK> interpretation of " must " is that there is no longer patient choice PK> involved. My experience has been exactly the opposite - it is PK> COMPLETELY the patient's choice between a Part A HHA or a Part B PK> therapy provider. We have been unable to find any references to the PK> contrary. PK> Thanks PK> Kovacek, PT PK> Harper Woods, MI PK> >> >> Hi Myrna, >> >> >> >> If an ALF or ILF resident meets the Part A Medicare definition of >> " homebound " and the standard home health requirements, then that PK> resident >> can be seen in their residence with services provided by a Medicare >> certified home health agency (and therapists in their employ or PK> contracted >> with them). As far as I know, if a beneficiary meets the PK> requirements for >> home health, then they must be seen by a home health certified PK> agency. You >> can't just bypass to Part B therapy if they meet the Part A PK> requirements. >> >> >> >> If the ALF or ILF resident no longer meets the requirements for PK> home health >> including not meeting the homebound requirement AND it can be PK> documented >> that there is a good reason why that resident cannot get to an PK> outpatient PT >> clinic (safety, cognition, transportation issues etc.), then PK> outpatient >> therapy (under Part B services)can be done at their residence. The PK> provider >> coming to the residence must be Medicare Part B certified. Wade PK> was correct >> in that there is no compensation for travel or travel time, only the >> standard outpatient billing as you would do in the clinic. The PK> important >> point is to document the reason why outpatient part B services need PK> to be >> done at the residence versus at an outpatient clinic. >> >> >> >> Any Medicare beneficiary starting outpatient PT needs to be PK> screened to make >> sure they have been discharged from a home health agency. It is PK> not easy to >> do and may require you to call the home health agency to check. PK> You will >> not get paid on an outpatient claim until the beneficiary is PK> discharged from >> home health. There is no easier way around this. Also the lines PK> between >> what qualifies for home health PT under Part A and outpatient PT PK> under Part >> B have a lot of gray areas. Your partner needs to be sure what PK> type of >> beneficiary the ALF and ILF are talking about. >> >> >> >> Finally, therapists/clinics do contract directly with the facility PK> and can >> set up a treatment area in the ALF or ILF and provide standard PK> outpatient >> treatment. It becomes a satellite clinic. This is a rare option PK> because >> that clinic must meet all the Medicare requirements for an PK> outpatient >> clinic-very costly and time consuming. >> >> >> >> Hope this helps! >> >> Tom Howell, P.T., M.P.T. >> >> Howell Physical Therapy >> >> Eagle, ID >> >> howellpt@... >> >> >> >> >> >> _____ >> >> From: PTManager [mailto:PTManager ] PK> On Behalf >> Of mposnerx >> Sent: Wednesday, April 23, 2008 6:11 AM >> To: PTManager >> Subject: ALF >> >> >> >> A partner that would like to remain anonymous has a clinic in PK> Kentucky. >> He has had contact from two facilities that are not happy with PK> their >> Home Health visits provded by a local nursing company. The two >> facilities are an Assisted Living Facility and an Independent PK> Living >> facility. They have approached his company and asked if he could >> provide PT & OT services in these settings. They have indicated PK> that >> these services might qualify for reimbursement as " home visits " . Is >> this true? >> >> The majority of the patients are covered by Medicare. Is there a >> difference in Medicare reimbursement if the patient is treated in PK> the >> ALF or ILF? Also, how do you determine if the patient is under a PK> home >> health agency Episode of Care? >> >> Any inpt would be appreciated. Thank you. >> >> Myrna Posner >> Allied Rehab >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 24, 2008 Report Share Posted April 24, 2008 As usual, is absoultely correct. We're converting a lot of home health to PT visits. Thanks for bringing that out in the open as we lose tons of business to those guys that we shouldn't and don't have to. For example, a Medicare patient can receive regular home health but still go to outpatient therapy. Doug Doug Sparks Advanced Physical Therapy Concepts / APTC www.aptc.biz<http://www.aptc.biz/> doug@... ALF > > > > A partner that would like to remain anonymous has a clinic in Kentucky. > He has had contact from two facilities that are not happy with their > Home Health visits provded by a local nursing company. The two > facilities are an Assisted Living Facility and an Independent Living > facility. They have approached his company and asked if he could > provide PT & OT services in these settings. They have indicated that > these services might qualify for reimbursement as " home visits " . Is > this true? > > The majority of the patients are covered by Medicare. Is there a > difference in Medicare reimbursement if the patient is treated in the > ALF or ILF? Also, how do you determine if the patient is under a home > health agency Episode of Care? > > Any inpt would be appreciated. Thank you. > > Myrna Posner > Allied Rehab > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 24, 2008 Report Share Posted April 24, 2008 Hi , Sorry to all. My reference was a home health agency that I worked for (don't any more). I apologize for the wrong information and appreciate the correction. In thinking about it, what the agency probably mixed up is the issue of choice. Since there is better coverage of PT under Part A versus Part B then they must have assumed that all beneficiaries would chose to be covered under Part A if they qualified under the Medicare rules for home health. That got translated as a " must " somewhere along the way. I don't have a CMS reference at this time to clarify either. Thanks again for the correction. Tom Howell, P.T., M.P.T. Howell Physical Therapy Eagle, ID howellpt@... _____ From: PTManager [mailto:PTManager ] On Behalf Of Kovacek Sent: Thursday, April 24, 2008 9:08 AM To: PTManager Subject: Re: ALF Tom In your previous response your wrote: " As far as I know, if a beneficiary meets the requirements for > home health, then they must be seen by a home health certified agency. You > can't just bypass to Part B therapy if they meet the Part A requirements. " Please provide a reference for this " must " statement. My interpretation of " must " is that there is no longer patient choice involved. My experience has been exactly the opposite - it is COMPLETELY the patient's choice between a Part A HHA or a Part B therapy provider. We have been unable to find any references to the contrary. Thanks Kovacek, PT Harper Woods, MI > > Hi Myrna, > > > > If an ALF or ILF resident meets the Part A Medicare definition of > " homebound " and the standard home health requirements, then that resident > can be seen in their residence with services provided by a Medicare > certified home health agency (and therapists in their employ or contracted > with them). As far as I know, if a beneficiary meets the requirements for > home health, then they must be seen by a home health certified agency. You > can't just bypass to Part B therapy if they meet the Part A requirements. > > > > If the ALF or ILF resident no longer meets the requirements for home health > including not meeting the homebound requirement AND it can be documented > that there is a good reason why that resident cannot get to an outpatient PT > clinic (safety, cognition, transportation issues etc.), then outpatient > therapy (under Part B services)can be done at their residence. The provider > coming to the residence must be Medicare Part B certified. Wade was correct > in that there is no compensation for travel or travel time, only the > standard outpatient billing as you would do in the clinic. The important > point is to document the reason why outpatient part B services need to be > done at the residence versus at an outpatient clinic. > > > > Any Medicare beneficiary starting outpatient PT needs to be screened to make > sure they have been discharged from a home health agency. It is not easy to > do and may require you to call the home health agency to check. You will > not get paid on an outpatient claim until the beneficiary is discharged from > home health. There is no easier way around this. Also the lines between > what qualifies for home health PT under Part A and outpatient PT under Part > B have a lot of gray areas. Your partner needs to be sure what type of > beneficiary the ALF and ILF are talking about. > > > > Finally, therapists/clinics do contract directly with the facility and can > set up a treatment area in the ALF or ILF and provide standard outpatient > treatment. It becomes a satellite clinic. This is a rare option because > that clinic must meet all the Medicare requirements for an outpatient > clinic-very costly and time consuming. > > > > Hope this helps! > > Tom Howell, P.T., M.P.T. > > Howell Physical Therapy > > Eagle, ID > > howellpt@... > > > > > > _____ > > From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com [mailto:PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com] On Behalf > Of mposnerx > Sent: Wednesday, April 23, 2008 6:11 AM > To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com > Subject: ALF > > > > A partner that would like to remain anonymous has a clinic in Kentucky. > He has had contact from two facilities that are not happy with their > Home Health visits provded by a local nursing company. The two > facilities are an Assisted Living Facility and an Independent Living > facility. They have approached his company and asked if he could > provide PT & OT services in these settings. They have indicated that > these services might qualify for reimbursement as " home visits " . Is > this true? > > The majority of the patients are covered by Medicare. Is there a > difference in Medicare reimbursement if the patient is treated in the > ALF or ILF? Also, how do you determine if the patient is under a home > health agency Episode of Care? > > Any inpt would be appreciated. Thank you. > > Myrna Posner > Allied Rehab > > > > > > Quote Link to comment Share on other sites More sharing options...
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