Re: Medicare Part B and Assisted Living

[Guest guest]

Assisted living is their home so yes it is reimbursable under Part B if not

under home health.

Sent from my Cellular South BlackBerry® Smartphone

Medicare Part B and Assisted Living

I do know as a Part B Medicare provider in Texas, a patient can be seen in their

home and the treatment is remibursable.

My question is if a patient lives in Assisted Living or Independent Senior

Apartmnets, AND not being seen by Home Health, is the treatment remibursable?

I was not sure if Medicare excludes these facilities for Part B Providers.

thank you.

Ruesewald

Therapy Billing

[Guest guest]

The answer to your question can be found in CMS Pub 100-02, Chapter 15, Section

230.4B.

Coverage of outpatient therapy under Part B includes the services of a qualified

TPP when furnished in the therapist’s office or the beneficiary’s home. For

this purpose, “home†includes an institution that is used as a home, but not

a hospital, CAH or SNF, (Federal Register Nov. 2, 1998, pg 58869). Place of

Service (POS) includes:

•    03/School, only if residential, •    04/Homeless Shelter,

•    12/Home, other than a facility that is a private residence, •   

14/Group Home, •    33/Custodial Care Facility.

http://www.cms.gov/manuals/Downloads/bp102c15.pdf

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Subject: Medicare Part B and Assisted Living

To: PTManager

Date: Tuesday, January 25, 2011, 4:20 PM

 

I do know as a Part B Medicare provider in Texas, a patient can be seen in

their home and the treatment is remibursable.

My question is if a patient lives in Assisted Living or Independent Senior

Apartmnets, AND not being seen by Home Health, is the treatment remibursable?

I was not sure if Medicare excludes these facilities for Part B Providers.

thank you.

Ruesewald

Therapy Billing

[Guest guest]

The answer to your question can be found in CMS Pub 100-02, Chapter 15, Section

230.4B.

Coverage of outpatient therapy under Part B includes the services of a qualified

TPP when furnished in the therapist’s office or the beneficiary’s home. For

this purpose, “home†includes an institution that is used as a home, but not

a hospital, CAH or SNF, (Federal Register Nov. 2, 1998, pg 58869). Place of

Service (POS) includes:

•    03/School, only if residential, •    04/Homeless Shelter,

•    12/Home, other than a facility that is a private residence, •   

14/Group Home, •    33/Custodial Care Facility.

http://www.cms.gov/manuals/Downloads/bp102c15.pdf

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Subject: Medicare Part B and Assisted Living

To: PTManager

Date: Tuesday, January 25, 2011, 4:20 PM

 

I do know as a Part B Medicare provider in Texas, a patient can be seen in

their home and the treatment is remibursable.

My question is if a patient lives in Assisted Living or Independent Senior

Apartmnets, AND not being seen by Home Health, is the treatment remibursable?

I was not sure if Medicare excludes these facilities for Part B Providers.

thank you.

Ruesewald

Therapy Billing

[Guest guest]

The answer to your question can be found in CMS Pub 100-02, Chapter 15, Section

230.4B.

Coverage of outpatient therapy under Part B includes the services of a qualified

TPP when furnished in the therapist’s office or the beneficiary’s home. For

this purpose, “home†includes an institution that is used as a home, but not

a hospital, CAH or SNF, (Federal Register Nov. 2, 1998, pg 58869). Place of

Service (POS) includes:

•    03/School, only if residential, •    04/Homeless Shelter,

•    12/Home, other than a facility that is a private residence, •   

14/Group Home, •    33/Custodial Care Facility.

http://www.cms.gov/manuals/Downloads/bp102c15.pdf

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Subject: Medicare Part B and Assisted Living

To: PTManager

Date: Tuesday, January 25, 2011, 4:20 PM

 

I do know as a Part B Medicare provider in Texas, a patient can be seen in

their home and the treatment is remibursable.

My question is if a patient lives in Assisted Living or Independent Senior

Apartmnets, AND not being seen by Home Health, is the treatment remibursable?

I was not sure if Medicare excludes these facilities for Part B Providers.

thank you.

Ruesewald

Therapy Billing

[Guest guest]

I know that some facilities do contract with entities to provide PT when

ordered (still on an outpatient basis, not as part of the staff)but the

answer depends on state law. Here in Idaho the patient/clients have the

choice, not the facility. When a contract is in place, the facility can

recommend the contracted therapist but the decision is up to the

patient/client or their power of attorney.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of Mark Niles

Sent: Wednesday, January 26, 2011 6:25 AM

To: PTManager

Subject: RE: Medicare Part B and Assisted Living

With this in mind PT in a ALF or Independent facility, if the pt wanted a

specific PT for their care, is that the decision of the pt or would the

facility step in? and do most of these facilities have their own staff, and

are they open ot outside contracting? These facilities do not bill under m/c

A?

thanks

Mark Niles PT, MS, CSCS

Orthopedic Specialists PA

mniles@... <mailto:mniles%40orthospecpa.net>

x3

fax

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From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of M. Howell, PT, MPT

Sent: Tuesday, January 25, 2011 5:27 PM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: RE: Medicare Part B and Assisted Living

Hi ,

I have never had any problem getting reimbursed for Part B services done at

an Assisted Living or Independent Senior Apartment setting. Both are

considered the patient/client's residence/home. The only extra thing is

that in the Assisted Living centers I have worked with, I communicated with

staff from the day of evaluation through discharge, either personally or via

treatment notes to keep them updated. That would include any staff training

that may need to be done in some cases. Each facility will have their own

preferences. The most common request I have had is to fax the daily

treatment note to the facility or bring it at the next visit (remember to

keep in mind HIPAA laws).

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@... <mailto:thowell%40fiberpipe.net>

<mailto:thowell%40fiberpipe.net>

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

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copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

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From: PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of therapybilling

Sent: Tuesday, January 25, 2011 2:21 PM

To: PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com>

Subject: Medicare Part B and Assisted Living

I do know as a Part B Medicare provider in Texas, a patient can be seen in

their home and the treatment is remibursable.

My question is if a patient lives in Assisted Living or Independent Senior

Apartmnets, AND not being seen by Home Health, is the treatment

remibursable?

I was not sure if Medicare excludes these facilities for Part B Providers.

thank you.

Ruesewald

Therapy Billing