Guest guest Posted June 26, 2003 Report Share Posted June 26, 2003 I was talking with someone well connected with the American Liver Foundation. This person told me that The ALF used to be involved with Patient Support, but 'it pulled too many resources' so now they fundraise strictly for research. Sorry I am sounding negative. The way I translate that is - Instead of a hospital getting $1.00 for research and using $.80 for direct research expenses and $.20 for overhead (administration) the ALF gets $100 gives the Reasearch Center $.80 and the ALF uses $.20 for admin overhead. The research Center uses $.64 for research and $.16 for admin overhead. If someone wants to donate money for Liver research they may as well donate it to the Mayo clinic, or some other similiar research center. I know that they Mayo is currently doing two research studies for PSC. a) a multi center study of increased doses of Urso. a study on the use of Remicade in PSC, (it seems promisisng) (I also heard that the Mayo is esearching the use of nicotine for UC, they are currently researching the best delivery method - patches, gum etc.) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2003 Report Share Posted June 26, 2003 sorry for not signing previous email Saul UC 94 - PSC - 95 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2008 Report Share Posted April 23, 2008 A partner that would like to remain anonymous has a clinic in Kentucky. He has had contact from two facilities that are not happy with their Home Health visits provded by a local nursing company. The two facilities are an Assisted Living Facility and an Independent Living facility. They have approached his company and asked if he could provide PT & OT services in these settings. They have indicated that these services might qualify for reimbursement as " home visits " . Is this true? The majority of the patients are covered by Medicare. Is there a difference in Medicare reimbursement if the patient is treated in the ALF or ILF? Also, how do you determine if the patient is under a home health agency Episode of Care? Any inpt would be appreciated. Thank you. Myrna Posner Allied Rehab Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2008 Report Share Posted April 23, 2008 Hi Myrna, If an ALF or ILF resident meets the Part A Medicare definition of " homebound " and the standard home health requirements, then that resident can be seen in their residence with services provided by a Medicare certified home health agency (and therapists in their employ or contracted with them). As far as I know, if a beneficiary meets the requirements for home health, then they must be seen by a home health certified agency. You can't just bypass to Part B therapy if they meet the Part A requirements. If the ALF or ILF resident no longer meets the requirements for home health including not meeting the homebound requirement AND it can be documented that there is a good reason why that resident cannot get to an outpatient PT clinic (safety, cognition, transportation issues etc.), then outpatient therapy (under Part B services)can be done at their residence. The provider coming to the residence must be Medicare Part B certified. Wade was correct in that there is no compensation for travel or travel time, only the standard outpatient billing as you would do in the clinic. The important point is to document the reason why outpatient part B services need to be done at the residence versus at an outpatient clinic. Any Medicare beneficiary starting outpatient PT needs to be screened to make sure they have been discharged from a home health agency. It is not easy to do and may require you to call the home health agency to check. You will not get paid on an outpatient claim until the beneficiary is discharged from home health. There is no easier way around this. Also the lines between what qualifies for home health PT under Part A and outpatient PT under Part B have a lot of gray areas. Your partner needs to be sure what type of beneficiary the ALF and ILF are talking about. Finally, therapists/clinics do contract directly with the facility and can set up a treatment area in the ALF or ILF and provide standard outpatient treatment. It becomes a satellite clinic. This is a rare option because that clinic must meet all the Medicare requirements for an outpatient clinic-very costly and time consuming. Hope this helps! Tom Howell, P.T., M.P.T. Howell Physical Therapy Eagle, ID howellpt@... _____ From: PTManager [mailto:PTManager ] On Behalf Of mposnerx Sent: Wednesday, April 23, 2008 6:11 AM To: PTManager Subject: ALF A partner that would like to remain anonymous has a clinic in Kentucky. He has had contact from two facilities that are not happy with their Home Health visits provded by a local nursing company. The two facilities are an Assisted Living Facility and an Independent Living facility. They have approached his company and asked if he could provide PT & OT services in these settings. They have indicated that these services might qualify for reimbursement as " home visits " . Is this true? The majority of the patients are covered by Medicare. Is there a difference in Medicare reimbursement if the patient is treated in the ALF or ILF? Also, how do you determine if the patient is under a home health agency Episode of Care? Any inpt would be appreciated. Thank you. Myrna Posner Allied Rehab Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 24, 2008 Report Share Posted April 24, 2008 Tom In your previous response your wrote: " As far as I know, if a beneficiary meets the requirements for > home health, then they must be seen by a home health certified agency. You > can't just bypass to Part B therapy if they meet the Part A requirements. " Please provide a reference for this " must " statement. My interpretation of " must " is that there is no longer patient choice involved. My experience has been exactly the opposite - it is COMPLETELY the patient's choice between a Part A HHA or a Part B therapy provider. We have been unable to find any references to the contrary. Thanks Kovacek, PT Harper Woods, MI > > Hi Myrna, > > > > If an ALF or ILF resident meets the Part A Medicare definition of > " homebound " and the standard home health requirements, then that resident > can be seen in their residence with services provided by a Medicare > certified home health agency (and therapists in their employ or contracted > with them). As far as I know, if a beneficiary meets the requirements for > home health, then they must be seen by a home health certified agency. You > can't just bypass to Part B therapy if they meet the Part A requirements. > > > > If the ALF or ILF resident no longer meets the requirements for home health > including not meeting the homebound requirement AND it can be documented > that there is a good reason why that resident cannot get to an outpatient PT > clinic (safety, cognition, transportation issues etc.), then outpatient > therapy (under Part B services)can be done at their residence. The provider > coming to the residence must be Medicare Part B certified. Wade was correct > in that there is no compensation for travel or travel time, only the > standard outpatient billing as you would do in the clinic. The important > point is to document the reason why outpatient part B services need to be > done at the residence versus at an outpatient clinic. > > > > Any Medicare beneficiary starting outpatient PT needs to be screened to make > sure they have been discharged from a home health agency. It is not easy to > do and may require you to call the home health agency to check. You will > not get paid on an outpatient claim until the beneficiary is discharged from > home health. There is no easier way around this. Also the lines between > what qualifies for home health PT under Part A and outpatient PT under Part > B have a lot of gray areas. Your partner needs to be sure what type of > beneficiary the ALF and ILF are talking about. > > > > Finally, therapists/clinics do contract directly with the facility and can > set up a treatment area in the ALF or ILF and provide standard outpatient > treatment. It becomes a satellite clinic. This is a rare option because > that clinic must meet all the Medicare requirements for an outpatient > clinic-very costly and time consuming. > > > > Hope this helps! > > Tom Howell, P.T., M.P.T. > > Howell Physical Therapy > > Eagle, ID > > howellpt@... > > > > > > _____ > > From: PTManager [mailto:PTManager ] On Behalf > Of mposnerx > Sent: Wednesday, April 23, 2008 6:11 AM > To: PTManager > Subject: ALF > > > > A partner that would like to remain anonymous has a clinic in Kentucky. > He has had contact from two facilities that are not happy with their > Home Health visits provded by a local nursing company. The two > facilities are an Assisted Living Facility and an Independent Living > facility. They have approached his company and asked if he could > provide PT & OT services in these settings. They have indicated that > these services might qualify for reimbursement as " home visits " . Is > this true? > > The majority of the patients are covered by Medicare. Is there a > difference in Medicare reimbursement if the patient is treated in the > ALF or ILF? Also, how do you determine if the patient is under a home > health agency Episode of Care? > > Any inpt would be appreciated. Thank you. > > Myrna Posner > Allied Rehab > > > > > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.