Eli's Rehab Report

Published on Fri Mar 30, 2012 PDF

The shoe may be on the other foot when you're the one furnishing Part B therapy.

Providing Part B outpatient therapy in a patient's home may seem like a boon to both the patient and you. But you'll be subject to the same payment restrictions as other Part B therapy providers, which means you'll need to be on the lookout for another home care provider's presence or risk your payment.

Reminder: The Medicare program does not reimburse separately for outpatient therapy services if the Medicare beneficiary is also simultaneously receiving any type of home health services being reimbursed under the Medicare Part A benefit, explains physical therapist Rick Gawenda, president of Gawenda Seminars & Consulting Inc.

When another HHA is furnishing home care, the provider of the outpatient services would either have its claim denied when submitted or be reimbursed for their services and then have the money taken back once the home health agency submitted its claim for payment.

The provider of outpatient therapy services essentially has no appeal rights, Gawenda stresses. You can contact the other HHA to ask when they admitted or discharged the Medicare beneficiary from home care and double-check with your Medicare contractor to see if this is the same date it has in its system. If not, contact the other agency and ask it to correct the admission or discharge date with the Medicare contractor.

HHAs Don't Have To Pay For Outpatient Therapy

Once corrected, you would then be able to obtain reimbursement for outpatient therapy services that occurred before admission or after the discharge date from home care. Unless you have a contract in place with the other agency prior to providing the outpatient therapy services to the Medicare beneficiary, the agency is under no obligation to pay you for your services.

Benefit: This rule goes the same for you when other outpatient Part B providers show up to demand payment while a patient was on your service. That includes hospital outpatient therapy departments, experts note.

It is imperative to ask the patient and/or patient's family questions about receiving home care services prior to initiating outpatient therapy services, Gawenda advises. This would include asking the patient if they are receiving ANY type of home care services such as a nurse coming in AT ALL, a therapist coming in AT ALL, etc. Sometimes, patients may not realize a nurse coming in once per week or once every two weeks is home health services under the Medicare program.