Eli's Rehab Report

Published on Tue Jul 26, 2011 PDF

Consider these rules when it might be safer for patients to stay home.

Question: Some private practices in our area have begun providing services in their clients' homes. They bill units just like if the services were provided in the practice. How is this different from homecare? Shouldn't there be a different fee schedule and reimbursement approach for homecare versus outpatient treatment? Is this even legal?

Answer: No, it's not illegal -- Chapter 5 of the Centers for Medicare and Medicaid Services' Medicare Benefits Policy Manual clearly outlines how and when you can treat patients in their homes. Those rules are:

• You provide physical therapy, speech-language pathology, and occupational therapy
• Your patient is covered by Part B
• You bill for these services separately
• You correctly identify the location where youprovided the services
• You do not bill for transportation or other costs of offsite visits.

When: Seeing a patient in his or her home makes sense when the patient struggles to get to your office, notes Thomas Howell PT, MPT with Howell Physical Therapy in Eagle, Ida. For instance, perhaps there's winter weather that makes travel dangerous for someone with an elevated risk for falls or the patient was in an accident that makes it painful to travel by car. However, seeing patients at home probably shouldn't be your first line of attack. "Travel time is not reimbursed, so time management and productivity become difficult," Howell says.

Good idea: Medicare doesn't require that you document why you chose to treat the patient at home, but keeping a record of your reasoning will help you - and future auditors -- better understand why the patient needed to be treated in his or her home, Howell points out.

Remember: When you provide therapy to a patient at home, you must choose the correct place of service code on the 1500 claim form. You use code 11 for treatment at your practice, but code 12 is the correct choice when "the patient receives care in a private residence," CMS states.