RE: Part B billing for care in the home

[Guest guest]

Hi Matt,

1. To clarify for the list, we are talking about Medicare clients.

Medicare DOES allow Part B patients to be seen in their homes. Please note,

however, that if the client has non-Medicare insurance, you would have to

refer to the contract you have with the insurance to be sure you are allowed

to do this. We have never run into any insurance, so far, that has not

allowed this, though.

2. Most posts on this subject will usually warn of the significant

financial cost of this type of treatment because it is one-on-one time and

involves travel costs that can not be reimbursed. Please don't let that be

a deterrent. It is a tremendous and valuable service to your clients and

your community and is the right thing to do.

3. For new clients, another thing to be sure of is checking first to make

sure that the client is NOT a candidate for home health. While part A and

Part B services can be rendered under the same circumstances, you may create

ill will with area home health agencies if you are perceived as " stealing "

their patients. Also, remember that Part A services generally are covered

at 100% where Part B at 80% (after deductibles). A client that is eligible

for Part A or Part B services that has no co-insurance to cover the Part B

20% may not be happy to receive those bills. Same goes for the therapy cap.

Private practices will still be required to follow cap rules even if the

treatment is at home so keep that in mind. (Obviously if these are patients

that were already evaluated/continuing patients at your clinic, the above

does not apply).

4. A major thing that has to be done is that you must document (we do it in

the subjective part of our notes) why therapy is being done in the home: ie

" The patient is being seen at their home today because: the patient has no

transportation; the patient ambulates with a walker and conditions outside

make it unsafe to do so " , etc., etc.

5. Billing is done the same as it is done in the clinic. While you can

bill a good amount of one-on-one time, remember, you cannot bill for down

time or rest time.

6. Be careful with Medicare Advantage (Medicare HMO's) clients. They may

have different rules built into the contract with your facility. Also, you

are generally still required to collect co-pays even if you see the client

at home. Make sure that you have a policy for this and are able to make

change.

7. Make sure that your therapists have visible indentifying ID.

8. If the therapist performing the service has never treated in the home,

make sure you do some inservicing about being respectful in a person's home

and some tips on how to treat in the home.

We have done just about any kind of treatment in the home, including taking

modality units there if appropriate. Most of the time we did it because of

the weather or transportation but there have been many cases where the

patient was in too much pain to get to the clinic as well (think early after

a motor vehicle accident). The clients are always transitioned to the

clinic and it is a very small part of our practice. I can't stress enough

how valuable a service this is and hope that you do commit to doing it.

Please feel free to contact me directly if you have additional questions.

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

Howell Physical Therapy

Eagle, ID

thowell@...

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

and that any use, dissemination, distribution, forwarding, printing or

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

attachments and notify the sender by reply email.

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Matt Dvorak

Sent: Thursday, January 28, 2010 9:20 AM

To: PTManager

Subject: Part B billing for care in the home

Several of our clients are unable to attend therapy here in South Dakota

during blizzards and following ice storms and with packed, slippery snow in

the streets and parking lots. If you know the midwest during winter, you

know that we go weeks/months with below freezing weather and the ice/snow

never melts from the sidewalks, driveways, and parking lots. We have many

cancellations due to the inability of patients getting into the department.

Question being: Does anyone see an issue with billinig Part B medicare for

in home visits in this situation. We have thought about seeing patients in

their home on a regular basis for an extended period of time due to this

issue. These patients aren't really " home bound " except for the slippery

conditins, therefore, I don't feel that we are stepping on home health

agencies' toes. Any comments are welcome.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

I work at a community hospital and we are interested in providing this

service. Our billing department is unsure if we can do this in a

hospital setting. Does anyone have experience doing this while billing

it through the hospital system. We would really like to be able to

provide this service when needed.

Lori Jarrett, PT

Director of Rehab Services

Shaw Bethea Hospital

Dixon, Illinois

________________________________

From: thomas m howell

Sent: Thursday, January 28, 2010 5:05 PM

To: PTManager

Subject: RE: Part B billing for care in the home

Hi Matt,

1. To clarify for the list, we are talking about Medicare clients.

Medicare DOES allow Part B patients to be seen in their homes. Please

note,

however, that if the client has non-Medicare insurance, you would have

to

refer to the contract you have with the insurance to be sure you are

allowed

to do this. We have never run into any insurance, so far, that has not

allowed this, though.

2. Most posts on this subject will usually warn of the significant

financial cost of this type of treatment because it is one-on-one time

and

involves travel costs that can not be reimbursed. Please don't let that

be

a deterrent. It is a tremendous and valuable service to your clients and

your community and is the right thing to do.

3. For new clients, another thing to be sure of is checking first to

make

sure that the client is NOT a candidate for home health. While part A

and

Part B services can be rendered under the same circumstances, you may

create

ill will with area home health agencies if you are perceived as

" stealing "

their patients. Also, remember that Part A services generally are

covered

at 100% where Part B at 80% (after deductibles). A client that is

eligible

for Part A or Part B services that has no co-insurance to cover the Part

B

20% may not be happy to receive those bills. Same goes for the therapy

cap.

Private practices will still be required to follow cap rules even if the

treatment is at home so keep that in mind. (Obviously if these are

patients

that were already evaluated/continuing patients at your clinic, the

above

does not apply).

4. A major thing that has to be done is that you must document (we do it

in

the subjective part of our notes) why therapy is being done in the home:

ie

" The patient is being seen at their home today because: the patient has

no

transportation; the patient ambulates with a walker and conditions

outside

make it unsafe to do so " , etc., etc.

5. Billing is done the same as it is done in the clinic. While you can

bill a good amount of one-on-one time, remember, you cannot bill for

down

time or rest time.

6. Be careful with Medicare Advantage (Medicare HMO's) clients. They may

have different rules built into the contract with your facility. Also,

you

are generally still required to collect co-pays even if you see the

client

at home. Make sure that you have a policy for this and are able to make

change.

7. Make sure that your therapists have visible indentifying ID.

8. If the therapist performing the service has never treated in the

home,

make sure you do some inservicing about being respectful in a person's

home

and some tips on how to treat in the home.

We have done just about any kind of treatment in the home, including

taking

modality units there if appropriate. Most of the time we did it because

of

the weather or transportation but there have been many cases where the

patient was in too much pain to get to the clinic as well (think early

after

a motor vehicle accident). The clients are always transitioned to the

clinic and it is a very small part of our practice. I can't stress

enough

how valuable a service this is and hope that you do commit to doing it.

Please feel free to contact me directly if you have additional

questions.

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

Howell Physical Therapy

Eagle, ID

thowell@... <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

and that any use, dissemination, distribution, forwarding, printing or

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

attachments and notify the sender by reply email.

_____

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

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

On Behalf

Of Matt Dvorak

Sent: Thursday, January 28, 2010 9:20 AM

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

Subject: Part B billing for care in the home

Several of our clients are unable to attend therapy here in South Dakota

during blizzards and following ice storms and with packed, slippery snow

in

the streets and parking lots. If you know the midwest during winter, you

know that we go weeks/months with below freezing weather and the

ice/snow

never melts from the sidewalks, driveways, and parking lots. We have

many

cancellations due to the inability of patients getting into the

department.

Question being: Does anyone see an issue with billinig Part B medicare

for

in home visits in this situation. We have thought about seeing patients

in

their home on a regular basis for an extended period of time due to this

issue. These patients aren't really " home bound " except for the slippery

conditins, therefore, I don't feel that we are stepping on home health

agencies' toes. Any comments are welcome.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

I work at a community hospital and we are interested in providing this

service. Our billing department is unsure if we can do this in a

hospital setting. Does anyone have experience doing this while billing

it through the hospital system. We would really like to be able to

provide this service when needed.

Lori Jarrett, PT

Director of Rehab Services

Shaw Bethea Hospital

Dixon, Illinois

________________________________

From: thomas m howell

Sent: Thursday, January 28, 2010 5:05 PM

To: PTManager

Subject: RE: Part B billing for care in the home

Hi Matt,

1. To clarify for the list, we are talking about Medicare clients.

Medicare DOES allow Part B patients to be seen in their homes. Please

note,

however, that if the client has non-Medicare insurance, you would have

to

refer to the contract you have with the insurance to be sure you are

allowed

to do this. We have never run into any insurance, so far, that has not

allowed this, though.

2. Most posts on this subject will usually warn of the significant

financial cost of this type of treatment because it is one-on-one time

and

involves travel costs that can not be reimbursed. Please don't let that

be

a deterrent. It is a tremendous and valuable service to your clients and

your community and is the right thing to do.

3. For new clients, another thing to be sure of is checking first to

make

sure that the client is NOT a candidate for home health. While part A

and

Part B services can be rendered under the same circumstances, you may

create

ill will with area home health agencies if you are perceived as

" stealing "

their patients. Also, remember that Part A services generally are

covered

at 100% where Part B at 80% (after deductibles). A client that is

eligible

for Part A or Part B services that has no co-insurance to cover the Part

B

20% may not be happy to receive those bills. Same goes for the therapy

cap.

Private practices will still be required to follow cap rules even if the

treatment is at home so keep that in mind. (Obviously if these are

patients

that were already evaluated/continuing patients at your clinic, the

above

does not apply).

4. A major thing that has to be done is that you must document (we do it

in

the subjective part of our notes) why therapy is being done in the home:

ie

" The patient is being seen at their home today because: the patient has

no

transportation; the patient ambulates with a walker and conditions

outside

make it unsafe to do so " , etc., etc.

5. Billing is done the same as it is done in the clinic. While you can

bill a good amount of one-on-one time, remember, you cannot bill for

down

time or rest time.

6. Be careful with Medicare Advantage (Medicare HMO's) clients. They may

have different rules built into the contract with your facility. Also,

you

are generally still required to collect co-pays even if you see the

client

at home. Make sure that you have a policy for this and are able to make

change.

7. Make sure that your therapists have visible indentifying ID.

8. If the therapist performing the service has never treated in the

home,

make sure you do some inservicing about being respectful in a person's

home

and some tips on how to treat in the home.

We have done just about any kind of treatment in the home, including

taking

modality units there if appropriate. Most of the time we did it because

of

the weather or transportation but there have been many cases where the

patient was in too much pain to get to the clinic as well (think early

after

a motor vehicle accident). The clients are always transitioned to the

clinic and it is a very small part of our practice. I can't stress

enough

how valuable a service this is and hope that you do commit to doing it.

Please feel free to contact me directly if you have additional

questions.

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

Howell Physical Therapy

Eagle, ID

thowell@... <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

and that any use, dissemination, distribution, forwarding, printing or

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

attachments and notify the sender by reply email.

_____

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

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

On Behalf

Of Matt Dvorak

Sent: Thursday, January 28, 2010 9:20 AM

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

Subject: Part B billing for care in the home

Several of our clients are unable to attend therapy here in South Dakota

during blizzards and following ice storms and with packed, slippery snow

in

the streets and parking lots. If you know the midwest during winter, you

know that we go weeks/months with below freezing weather and the

ice/snow

never melts from the sidewalks, driveways, and parking lots. We have

many

cancellations due to the inability of patients getting into the

department.

Question being: Does anyone see an issue with billinig Part B medicare

for

in home visits in this situation. We have thought about seeing patients

in

their home on a regular basis for an extended period of time due to this

issue. These patients aren't really " home bound " except for the slippery

conditins, therefore, I don't feel that we are stepping on home health

agencies' toes. Any comments are welcome.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

I work at a community hospital and we are interested in providing this

service. Our billing department is unsure if we can do this in a

hospital setting. Does anyone have experience doing this while billing

it through the hospital system. We would really like to be able to

provide this service when needed.

Lori Jarrett, PT

Director of Rehab Services

Shaw Bethea Hospital

Dixon, Illinois

________________________________

From: thomas m howell

Sent: Thursday, January 28, 2010 5:05 PM

To: PTManager

Subject: RE: Part B billing for care in the home

Hi Matt,

1. To clarify for the list, we are talking about Medicare clients.

Medicare DOES allow Part B patients to be seen in their homes. Please

note,

however, that if the client has non-Medicare insurance, you would have

to

refer to the contract you have with the insurance to be sure you are

allowed

to do this. We have never run into any insurance, so far, that has not

allowed this, though.

2. Most posts on this subject will usually warn of the significant

financial cost of this type of treatment because it is one-on-one time

and

involves travel costs that can not be reimbursed. Please don't let that

be

a deterrent. It is a tremendous and valuable service to your clients and

your community and is the right thing to do.

3. For new clients, another thing to be sure of is checking first to

make

sure that the client is NOT a candidate for home health. While part A

and

Part B services can be rendered under the same circumstances, you may

create

ill will with area home health agencies if you are perceived as

" stealing "

their patients. Also, remember that Part A services generally are

covered

at 100% where Part B at 80% (after deductibles). A client that is

eligible

for Part A or Part B services that has no co-insurance to cover the Part

B

20% may not be happy to receive those bills. Same goes for the therapy

cap.

Private practices will still be required to follow cap rules even if the

treatment is at home so keep that in mind. (Obviously if these are

patients

that were already evaluated/continuing patients at your clinic, the

above

does not apply).

4. A major thing that has to be done is that you must document (we do it

in

the subjective part of our notes) why therapy is being done in the home:

ie

" The patient is being seen at their home today because: the patient has

no

transportation; the patient ambulates with a walker and conditions

outside

make it unsafe to do so " , etc., etc.

5. Billing is done the same as it is done in the clinic. While you can

bill a good amount of one-on-one time, remember, you cannot bill for

down

time or rest time.

6. Be careful with Medicare Advantage (Medicare HMO's) clients. They may

have different rules built into the contract with your facility. Also,

you

are generally still required to collect co-pays even if you see the

client

at home. Make sure that you have a policy for this and are able to make

change.

7. Make sure that your therapists have visible indentifying ID.

8. If the therapist performing the service has never treated in the

home,

make sure you do some inservicing about being respectful in a person's

home

and some tips on how to treat in the home.

We have done just about any kind of treatment in the home, including

taking

modality units there if appropriate. Most of the time we did it because

of

the weather or transportation but there have been many cases where the

patient was in too much pain to get to the clinic as well (think early

after

a motor vehicle accident). The clients are always transitioned to the

clinic and it is a very small part of our practice. I can't stress

enough

how valuable a service this is and hope that you do commit to doing it.

Please feel free to contact me directly if you have additional

questions.

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

Howell Physical Therapy

Eagle, ID

thowell@... <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

and that any use, dissemination, distribution, forwarding, printing or

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

attachments and notify the sender by reply email.

_____

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

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

On Behalf

Of Matt Dvorak

Sent: Thursday, January 28, 2010 9:20 AM

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

Subject: Part B billing for care in the home

Several of our clients are unable to attend therapy here in South Dakota

during blizzards and following ice storms and with packed, slippery snow

in

the streets and parking lots. If you know the midwest during winter, you

know that we go weeks/months with below freezing weather and the

ice/snow

never melts from the sidewalks, driveways, and parking lots. We have

many

cancellations due to the inability of patients getting into the

department.

Question being: Does anyone see an issue with billinig Part B medicare

for

in home visits in this situation. We have thought about seeing patients

in

their home on a regular basis for an extended period of time due to this

issue. These patients aren't really " home bound " except for the slippery

conditins, therefore, I don't feel that we are stepping on home health

agencies' toes. Any comments are welcome.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

Excellent response Matt, We have had all of his issues below with Part B

Medicare in the home. Ours was billed thru the hospital billing department and

did not have issue with this other than what Matt has brought up below. The only

thing I may add is that it was difficult to describe to the inpatient discharge

planning teams/physicians that this service was available to those who were

homebound but did not need nursing care. If the needed nursing care then home

health was ordered. It took quite a bit of education in this area.

Carl Grota, MSPT

DCMH Rehab Services

Sturgeon Bay, WI

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

thomas m howell

Sent: Thursday, January 28, 2010 5:05 PM

To: PTManager

Subject: RE: Part B billing for care in the home

Hi Matt,

1. To clarify for the list, we are talking about Medicare clients.

Medicare DOES allow Part B patients to be seen in their homes. Please note,

however, that if the client has non-Medicare insurance, you would have to

refer to the contract you have with the insurance to be sure you are allowed

to do this. We have never run into any insurance, so far, that has not

allowed this, though.

2. Most posts on this subject will usually warn of the significant

financial cost of this type of treatment because it is one-on-one time and

involves travel costs that can not be reimbursed. Please don't let that be

a deterrent. It is a tremendous and valuable service to your clients and

your community and is the right thing to do.

3. For new clients, another thing to be sure of is checking first to make

sure that the client is NOT a candidate for home health. While part A and

Part B services can be rendered under the same circumstances, you may create

ill will with area home health agencies if you are perceived as " stealing "

their patients. Also, remember that Part A services generally are covered

at 100% where Part B at 80% (after deductibles). A client that is eligible

for Part A or Part B services that has no co-insurance to cover the Part B

20% may not be happy to receive those bills. Same goes for the therapy cap.

Private practices will still be required to follow cap rules even if the

treatment is at home so keep that in mind. (Obviously if these are patients

that were already evaluated/continuing patients at your clinic, the above

does not apply).

4. A major thing that has to be done is that you must document (we do it in

the subjective part of our notes) why therapy is being done in the home: ie

" The patient is being seen at their home today because: the patient has no

transportation; the patient ambulates with a walker and conditions outside

make it unsafe to do so " , etc., etc.

5. Billing is done the same as it is done in the clinic. While you can

bill a good amount of one-on-one time, remember, you cannot bill for down

time or rest time.

6. Be careful with Medicare Advantage (Medicare HMO's) clients. They may

have different rules built into the contract with your facility. Also, you

are generally still required to collect co-pays even if you see the client

at home. Make sure that you have a policy for this and are able to make

change.

7. Make sure that your therapists have visible indentifying ID.

8. If the therapist performing the service has never treated in the home,

make sure you do some inservicing about being respectful in a person's home

and some tips on how to treat in the home.

We have done just about any kind of treatment in the home, including taking

modality units there if appropriate. Most of the time we did it because of

the weather or transportation but there have been many cases where the

patient was in too much pain to get to the clinic as well (think early after

a motor vehicle accident). The clients are always transitioned to the

clinic and it is a very small part of our practice. I can't stress enough

how valuable a service this is and hope that you do commit to doing it.

Please feel free to contact me directly if you have additional questions.

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

Howell Physical Therapy

Eagle, ID

thowell@...<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

and that any use, dissemination, distribution, forwarding, printing or

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

attachments and notify the sender by reply email.

_____

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

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

Of Matt Dvorak

Sent: Thursday, January 28, 2010 9:20 AM

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

Subject: Part B billing for care in the home

Several of our clients are unable to attend therapy here in South Dakota

during blizzards and following ice storms and with packed, slippery snow in

the streets and parking lots. If you know the midwest during winter, you

know that we go weeks/months with below freezing weather and the ice/snow

never melts from the sidewalks, driveways, and parking lots. We have many

cancellations due to the inability of patients getting into the department.

Question being: Does anyone see an issue with billinig Part B medicare for

in home visits in this situation. We have thought about seeing patients in

their home on a regular basis for an extended period of time due to this

issue. These patients aren't really " home bound " except for the slippery

conditins, therefore, I don't feel that we are stepping on home health

agencies' toes. Any comments are welcome.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

Excellent response Matt, We have had all of his issues below with Part B

Medicare in the home. Ours was billed thru the hospital billing department and

did not have issue with this other than what Matt has brought up below. The only

thing I may add is that it was difficult to describe to the inpatient discharge

planning teams/physicians that this service was available to those who were

homebound but did not need nursing care. If the needed nursing care then home

health was ordered. It took quite a bit of education in this area.

Carl Grota, MSPT

DCMH Rehab Services

Sturgeon Bay, WI

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

thomas m howell

Sent: Thursday, January 28, 2010 5:05 PM

To: PTManager

Subject: RE: Part B billing for care in the home

Hi Matt,

1. To clarify for the list, we are talking about Medicare clients.

Medicare DOES allow Part B patients to be seen in their homes. Please note,

however, that if the client has non-Medicare insurance, you would have to

refer to the contract you have with the insurance to be sure you are allowed

to do this. We have never run into any insurance, so far, that has not

allowed this, though.

2. Most posts on this subject will usually warn of the significant

financial cost of this type of treatment because it is one-on-one time and

involves travel costs that can not be reimbursed. Please don't let that be

a deterrent. It is a tremendous and valuable service to your clients and

your community and is the right thing to do.

3. For new clients, another thing to be sure of is checking first to make

sure that the client is NOT a candidate for home health. While part A and

Part B services can be rendered under the same circumstances, you may create

ill will with area home health agencies if you are perceived as " stealing "

their patients. Also, remember that Part A services generally are covered

at 100% where Part B at 80% (after deductibles). A client that is eligible

for Part A or Part B services that has no co-insurance to cover the Part B

20% may not be happy to receive those bills. Same goes for the therapy cap.

Private practices will still be required to follow cap rules even if the

treatment is at home so keep that in mind. (Obviously if these are patients

that were already evaluated/continuing patients at your clinic, the above

does not apply).

4. A major thing that has to be done is that you must document (we do it in

the subjective part of our notes) why therapy is being done in the home: ie

" The patient is being seen at their home today because: the patient has no

transportation; the patient ambulates with a walker and conditions outside

make it unsafe to do so " , etc., etc.

5. Billing is done the same as it is done in the clinic. While you can

bill a good amount of one-on-one time, remember, you cannot bill for down

time or rest time.

6. Be careful with Medicare Advantage (Medicare HMO's) clients. They may

have different rules built into the contract with your facility. Also, you

are generally still required to collect co-pays even if you see the client

at home. Make sure that you have a policy for this and are able to make

change.

7. Make sure that your therapists have visible indentifying ID.

8. If the therapist performing the service has never treated in the home,

make sure you do some inservicing about being respectful in a person's home

and some tips on how to treat in the home.

We have done just about any kind of treatment in the home, including taking

modality units there if appropriate. Most of the time we did it because of

the weather or transportation but there have been many cases where the

patient was in too much pain to get to the clinic as well (think early after

a motor vehicle accident). The clients are always transitioned to the

clinic and it is a very small part of our practice. I can't stress enough

how valuable a service this is and hope that you do commit to doing it.

Please feel free to contact me directly if you have additional questions.

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

Howell Physical Therapy

Eagle, ID

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

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

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_____

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

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

Of Matt Dvorak

Sent: Thursday, January 28, 2010 9:20 AM

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

Subject: Part B billing for care in the home

Several of our clients are unable to attend therapy here in South Dakota

during blizzards and following ice storms and with packed, slippery snow in

the streets and parking lots. If you know the midwest during winter, you

know that we go weeks/months with below freezing weather and the ice/snow

never melts from the sidewalks, driveways, and parking lots. We have many

cancellations due to the inability of patients getting into the department.

Question being: Does anyone see an issue with billinig Part B medicare for

in home visits in this situation. We have thought about seeing patients in

their home on a regular basis for an extended period of time due to this

issue. These patients aren't really " home bound " except for the slippery

conditins, therefore, I don't feel that we are stepping on home health

agencies' toes. Any comments are welcome.

Matt Dvorak, PT

Yankton, SD

[Guest guest]

Excellent response Matt, We have had all of his issues below with Part B

Medicare in the home. Ours was billed thru the hospital billing department and

did not have issue with this other than what Matt has brought up below. The only

thing I may add is that it was difficult to describe to the inpatient discharge

planning teams/physicians that this service was available to those who were

homebound but did not need nursing care. If the needed nursing care then home

health was ordered. It took quite a bit of education in this area.

Carl Grota, MSPT

DCMH Rehab Services

Sturgeon Bay, WI

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

thomas m howell

Sent: Thursday, January 28, 2010 5:05 PM

To: PTManager

Subject: RE: Part B billing for care in the home

Hi Matt,

1. To clarify for the list, we are talking about Medicare clients.

Medicare DOES allow Part B patients to be seen in their homes. Please note,

however, that if the client has non-Medicare insurance, you would have to

refer to the contract you have with the insurance to be sure you are allowed

to do this. We have never run into any insurance, so far, that has not

allowed this, though.

2. Most posts on this subject will usually warn of the significant

financial cost of this type of treatment because it is one-on-one time and

involves travel costs that can not be reimbursed. Please don't let that be

a deterrent. It is a tremendous and valuable service to your clients and

your community and is the right thing to do.

3. For new clients, another thing to be sure of is checking first to make

sure that the client is NOT a candidate for home health. While part A and

Part B services can be rendered under the same circumstances, you may create

ill will with area home health agencies if you are perceived as " stealing "

their patients. Also, remember that Part A services generally are covered

at 100% where Part B at 80% (after deductibles). A client that is eligible

for Part A or Part B services that has no co-insurance to cover the Part B

20% may not be happy to receive those bills. Same goes for the therapy cap.

Private practices will still be required to follow cap rules even if the

treatment is at home so keep that in mind. (Obviously if these are patients

that were already evaluated/continuing patients at your clinic, the above

does not apply).

4. A major thing that has to be done is that you must document (we do it in

the subjective part of our notes) why therapy is being done in the home: ie

" The patient is being seen at their home today because: the patient has no

transportation; the patient ambulates with a walker and conditions outside

make it unsafe to do so " , etc., etc.

5. Billing is done the same as it is done in the clinic. While you can

bill a good amount of one-on-one time, remember, you cannot bill for down

time or rest time.

6. Be careful with Medicare Advantage (Medicare HMO's) clients. They may

have different rules built into the contract with your facility. Also, you

are generally still required to collect co-pays even if you see the client

at home. Make sure that you have a policy for this and are able to make

change.

7. Make sure that your therapists have visible indentifying ID.

8. If the therapist performing the service has never treated in the home,

make sure you do some inservicing about being respectful in a person's home

and some tips on how to treat in the home.

We have done just about any kind of treatment in the home, including taking

modality units there if appropriate. Most of the time we did it because of

the weather or transportation but there have been many cases where the

patient was in too much pain to get to the clinic as well (think early after

a motor vehicle accident). The clients are always transitioned to the

clinic and it is a very small part of our practice. I can't stress enough

how valuable a service this is and hope that you do commit to doing it.

Please feel free to contact me directly if you have additional questions.

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

Howell Physical Therapy

Eagle, ID

thowell@...<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

and that any use, dissemination, distribution, forwarding, printing or

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

attachments and notify the sender by reply email.

_____

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

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

Of Matt Dvorak

Sent: Thursday, January 28, 2010 9:20 AM

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

Subject: Part B billing for care in the home

Several of our clients are unable to attend therapy here in South Dakota

during blizzards and following ice storms and with packed, slippery snow in

the streets and parking lots. If you know the midwest during winter, you

know that we go weeks/months with below freezing weather and the ice/snow

never melts from the sidewalks, driveways, and parking lots. We have many

cancellations due to the inability of patients getting into the department.

Question being: Does anyone see an issue with billinig Part B medicare for

in home visits in this situation. We have thought about seeing patients in

their home on a regular basis for an extended period of time due to this

issue. These patients aren't really " home bound " except for the slippery

conditins, therefore, I don't feel that we are stepping on home health

agencies' toes. Any comments are welcome.

Matt Dvorak, PT

Yankton, SD