Eli's Rehab Report

Published on Fri Oct 28, 2011 PDF

The following Q&As have been provided by Rick Gawenda, PT, president of Gawenda Seminars & Consulting Inc.

Question: Can Medicare patients receive outpatient therapy and home health nursing services during the same time period?

Answer: 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 Medicare Part A benefits. In this situation, the provider of the outpatient services would either have their claim denied when submitted or be reimbursed for their services and then have the money taken back once the home health agency submitted their claim for payment.

The provider of outpatient therapy services essentially has no appeal rights. You can contact the home health agency to ask when they discharged the Medicare beneficiary from home health services and double check with your Medicare contractor to see if this is the same date they have in their system. If not, contact the home health agency and ask them to correct the discharge date with the Medicare contractor. Once corrected, you would then be able to be reimbursed for outpatient therapy services that occurred after their discharge date from home health services. Unless you have a contract in place with the home health agency prior to providing the outpatient therapy services to the Medicare beneficiary, the home health agency is under no obligation to pay you for your services.

It is imperative to ask the patient and/or patient's family questions about receiving home health services prior to initiating outpatient therapy services. This would include asking the patient if they are receiving ANY type of home health 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 2 weeks is home health services under the Medicare program.

Question: If a PT and an OT are working with a child for a one hour session, but are addressing different goals/objectives, what can be charged for this type of treatment session? Both therapist are hands on; however, working on separate goals (i.e., OT fine motor, PT transitions) can they still bill for 60 minutes each or would it be 30 minutes each?

Answer: Since the child only received 60 minutes of therapy, they can only charge for 60 minutes of therapy. The PT and OT could not each charge 4 units as that would equate to approximately 2 hours of therapy. How the PT and OT want to divide the time would be based upon how much time each was "leading" the treatment session. Typically the PT and OT should bill for 2 units each. As you can imagine, while co-treatments may benefit the patient, they are not financially rewarding.

Source: Rick Gawenda, PT, consulting editor for Eli's Rehab Report. www.gawendaseminars.com