RE: home health and out pt PT

[Guest guest]

It would exclude in Texas.

The patient cant be on any Home Health program. The reasoning is if they

can get to you for PT, they can get to a nurse for wound care.

Ruesewald

Therapy Billing

PO Box 880 , Lake Dallas , TX 75065

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From: PTManager [mailto:PTManager ] On Behalf

Of Mark Niles

Sent: Wednesday, January 26, 2011 7:20 AM

To: PTManager

Subject: home health and out pt PT

Group,

Would a pt getting only wound care from a HH nurse exclude him from getting

out pt Pt for a different dx and body part? I am in Fl if that matters.

Mark Niles PT, MS, CSCS

Orthopedic Specialists PA

mniles@... <mailto:mniles%40orthospecpa.net>

x3

fax

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Of Kovacek

Sent: Wednesday, January 26, 2011 8:06 AM

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Subject: Now available on PTManager.com A Manager's Perspective:

Part 11 OF 14 - Measurement of Outcome Information. Discussion Documents To

Grow Your Management Skills

Now available on PTManager.com

A Manager's Perspective: Part 11 OF 14 - Measurement of Outcome Information.

Discussion Documents To Grow Your Management Skills

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[Guest guest]

Hi Mark,

Once the patient is under HHA, it excludes any other provider of needed

services that the HHA is expected to provide. It is called an episode of

care and the HHA receives a fixed amount of money to provide services. So in

this case, the HHA needs to provide therapy if needed. The fact that they

will probably not get the therapy to the extent that they would from a Part

B provider does not come into it. If you provide services, they will be

denied because of the open episode and so your only option would be to get

the HHA to reimburse you, which is not likely.

This is why it is so important to know if they are receiving any HHA

services, even if it is once a month for nursing needs. This is in all

States as it is a Federal program.

Hope this helps,

ine

ine M. o, PT, MCSP

Owner

Encompass Consulting & Education, LLC

8114 NW 100th Terrace, Tamarac, FL 33321-1259

We work hard to make sure you are " getting it right from the start " . Visit

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From: PTManager [mailto:PTManager ] On Behalf

Of Mark Niles

Sent: Wednesday, January 26, 2011 8:20 AM

To: PTManager

Subject: home health and out pt PT

Group,

Would a pt getting only wound care from a HH nurse exclude him from getting

out pt Pt for a different dx and body part? I am in Fl if that matters.

Mark Niles PT, MS, CSCS

Orthopedic Specialists PA

mniles@... <mailto:mniles%40orthospecpa.net>

x3

fax

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

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

Behalf

Of Kovacek

Sent: Wednesday, January 26, 2011 8:06 AM

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

Subject: Now available on PTManager.com A Manager's Perspective:

Part 11 OF 14 - Measurement of Outcome Information. Discussion Documents To

Grow Your Management Skills

Now available on PTManager.com

A Manager's Perspective: Part 11 OF 14 - Measurement of Outcome Information.

Discussion Documents To Grow Your Management Skills

http://post.ly/1X8vK

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[Guest guest]

Yes, and what's goofy is that they will pay the home health agency but not the

outpatient therapist.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc

Bay St. Louis and Diamondhead, Mississippi

Now available on PTManager.com A Manager's Perspective:

Part 11 OF 14 - Measurement of Outcome Information. Discussion Documents To

Grow Your Management Skills

Now available on PTManager.com

A Manager's Perspective: Part 11 OF 14 - Measurement of Outcome Information.

Discussion Documents To Grow Your Management Skills

http://post.ly/1X8vK

Kovacek, PT, MSA, DPT

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[Guest guest]

It depends on who is the payor for such home health aid services. If it's

Medicare, then the patient must still be under a Home Health episode. The

fact that the nurse of therapist has not visited the patient in a while

does not necessarily mean the patient has been discharged f/ the home health

agency.

If the home health aid services are private pay or covered under a Long

Term Care Insurance policy there sould be no problem billing Medicare part B.

Corneau, PT, MPT, GCS

Los Angeles, CA

In a message dated 1/27/2011 8:02:58 A.M. Pacific Standard Time,

rjlatc@... writes:

Tom:

Thank you for your response. Our outpatient practices have been throwing a

question around for a few weeks and I've even posted it to cms and our

intermediary, Highmark. I've gotten no response from either.

I understand about the nurse or therapist (PT or OT) coming to the house

to provide services. What happens if a patient was being seen several times

a week by a home health aide (to help with bathing, dressing, etc.). Would

the patient be able to come in as an outpatient for therapy services and

the outpatient practice be reimbursed by Medicare?

Thanks,

Bob

LaBelle, MBA, ATC

Utilization Coordinator

Good Shepherd Penn Partners

Penn Therapy & Fitness

>

> Hi Mark,

>

> I agree with the previous responses but let's look at it from the

> perspective of what is best for the patient/client. Medicare has put up

> hurdles but if this client needs services, we need to jump the hurdles

and

> get the patient/client the needed treatment. Here are some things to keep

> in mind.

>

>

>

> 1. Does the patient/client meet the definition of " homebound " ? If they do

> then they may qualify for home health PT instead.

>

>

>

> 2. If they do not qualify for homebound status and therefore do not

qualify

> for home health PT, can the home health agency provide their own

therapists

> to see the client. Many home health agencies will do this which is

> technically Part B services but they pay their therapists out of the

Part A

> reimbursement.

>

>

>

> 3. If # 2 is not available, then you can contract with the home health

> agency, see the patient/client and get paid by the home health agency. As

> we have heard on this list many times, this is a risky venture with the

> possibility of not getting paid and even legal action needed to get paid.

> BUT is it the right thing to do to get the services to the client?

>

>

>

> 4. Finally, if all other options are exhausted and if no other entity can

> provide PT services, see the patient/client, bill it via Part B, get your

> denial and either 1) write it off as pro bono care, 2) work out an

> arrangement with the patient/client to pay for treatment (this should be

> pre-arranged and an ABN is required) or 3) appeal to Medicare. If you can

> demonstrate that you went through steps 1, 2 and 3 above and that there

was

> no other way to get necessary treatment to the client, well you have a

shot

> at winning an appeal.

>

>

>

> Ultimately it is about you or your clinic/agency opting for a plan to get

> the needed services to the client, even if it is advising others of what

can

> be done.

>

>

>

> 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

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>

>

>

>

>

> _____

>

> From: _PTManager _ (mailto:PTManager )

[mailto:_PTManager _ (mailto:PTManager ) ] On

Behalf

> Of Mark Niles

> Sent: Wednesday, January 26, 2011 6:20 AM

> To: _PTManager _ (mailto:PTManager )

> Subject: home health and out pt PT

>

>

>

>

>

> Group,

>

> Would a pt getting only wound care from a HH nurse exclude him from

getting

> out pt Pt for a different dx and body part? I am in Fl if that matters.

>

> Mark Niles PT, MS, CSCS

> Orthopedic Specialists PA

> mniles@... <mailto:mniles%40orthospecpa.net>

> x3

> fax

>

> This message, together with any attachments, is intended only for the

> addressee. It may contain information which is legally privileged,

> confidential and exempt from disclosure. If you are not the intended

> recipient, you are hereby notified that any disclosure, copying,

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> strictly prohibited. If you have received this e-mail in error, please

> notify the sender immediately by telephone ( x3) or by return

> e-mail and delete the message, along with any attachments

>

> From: _PTManager _ (mailto:PTManager )

<mailto:PTManager%40yahoogroups.com>

> [mailto:_PTManager _ (mailto:PTManager )

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

> Behalf

> Of Kovacek

> Sent: Wednesday, January 26, 2011 8:06 AM

> To: _PTManager _ (mailto:PTManager )

<mailto:PTManager%40yahoogroups.com>

> Subject: Now available on PTManager.com A Manager's

Perspective:

> Part 11 OF 14 - Measurement of Outcome Information. Discussion Documents

To

> Grow Your Management Skills

>

> Now available on PTManager.com

>

> A Manager's Perspective: Part 11 OF 14 - Measurement of Outcome

Information.

> Discussion Documents To Grow Your Management Skills

> _http://post.ly/1X8vK_ (http://post.ly/1X8vK)

>

> Kovacek, PT, MSA, DPT

> PKovacek@... <mailto:PKovacek%40PTManager.com>

> <mailto:PKovacek%40PTManager.com>

> Cell

> Personal Fax

>

> Twitter.com/PKovacek

> Facebook.com/.Kovacek

>

> [Non-text portions of this message have been removed]

>

> [Non-text portions of this message have been removed]

>

>

>

>

>

> [Non-text portions of this message have been removed]

>

[Guest guest]

I would love feedback from this group as to what we could do with a patient

we have seen since October, 2010, just found out today that she has been

receiving home health care from the VNA since November, yet we have billed

Medicare for 2 months of service.

What is our responsibility to find out about this home health service when

it started after our services started and the patient did not inform us?

Do I have any leg to stand on here?

Thanks for your help!

===================================

*Maureen Whitney*

*Business Manager*

Essex Physical Therapy

Essex Junction, VT

maureen@...

[Guest guest]

Hi Bob,

A Medicare home health client must be fully discharged from any home health

services in order for you to get part B reimbursement. This is essentially

a computer thing as the patient/client has to show in the Medicare system as

discharged from home health for the system to accept a Part B claim. If it

doesn't, you will get a denial. The best option (s) in this case are to

talk to the home health agency and explain the rules and see when discharge

is planned and work with them on options to get PT treatment started sooner

than later (under the options in my last post). I would also talk to the

agency to make sure that the patient/client is no longer homebound as well

(which would lead to other options that I mentioned in that post).

No-one is saying that these regulations are good ones. They are not. There

are plenty of instances where a client is still receiving home health

nursing or other services for valid reasons but are not declared homebound

for PT. A good one is that they may not be homebound but they are not in a

situation to get to the needed nursing services or those services are not

available at a nearby clinic. While this is the case, it is also true that

some of these situations are artificially created by misunderstanding of

home health rules, especially homebound status. What I've seen is that PT

seems to err the most, unfortunately and patients/clients are discharged

from home health services too soon (for homebound status). Be sure about

homebound status first and remember that homebound status can be maintained

even if the patient/client goes out occasionally (ie for church, a family

event here and there, and for medical appointments). The key is how

difficult it is, what the physical and environmental barriers are and

whether it is safe for the patient/client to get out.

Past these concerns, it will still come down to what your clinic is able to

do to get needed services to the patient/client. There are options so don't

be afraid to jump the hurdles on behalf of your patient/clients!

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

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_____

From: PTManager [mailto:PTManager ] On Behalf

Of L

Sent: Thursday, January 27, 2011 6:33 AM

To: PTManager

Subject: Re: home health and out pt PT

Tom:

Thank you for your response. Our outpatient practices have been throwing a

question around for a few weeks and I've even posted it to cms and our

intermediary, Highmark. I've gotten no response from either.

I understand about the nurse or therapist (PT or OT) coming to the house to

provide services. What happens if a patient was being seen several times a

week by a home health aide (to help with bathing, dressing, etc.). Would the

patient be able to come in as an outpatient for therapy services and the

outpatient practice be reimbursed by Medicare?

Thanks,

Bob

LaBelle, MBA, ATC

Utilization Coordinator

Good Shepherd Penn Partners

Penn Therapy & Fitness

>

> Hi Mark,

>

> I agree with the previous responses but let's look at it from the

> perspective of what is best for the patient/client. Medicare has put up

> hurdles but if this client needs services, we need to jump the hurdles and

> get the patient/client the needed treatment. Here are some things to keep

> in mind.

>

>

>

> 1. Does the patient/client meet the definition of " homebound " ? If they do

> then they may qualify for home health PT instead.

>

>

>

> 2. If they do not qualify for homebound status and therefore do not

qualify

> for home health PT, can the home health agency provide their own

therapists

> to see the client. Many home health agencies will do this which is

> technically Part B services but they pay their therapists out of the Part

A

> reimbursement.

>

>

>

> 3. If # 2 is not available, then you can contract with the home health

> agency, see the patient/client and get paid by the home health agency. As

> we have heard on this list many times, this is a risky venture with the

> possibility of not getting paid and even legal action needed to get paid.

> BUT is it the right thing to do to get the services to the client?

>

>

>

> 4. Finally, if all other options are exhausted and if no other entity can

> provide PT services, see the patient/client, bill it via Part B, get your

> denial and either 1) write it off as pro bono care, 2) work out an

> arrangement with the patient/client to pay for treatment (this should be

> pre-arranged and an ABN is required) or 3) appeal to Medicare. If you can

> demonstrate that you went through steps 1, 2 and 3 above and that there

was

> no other way to get necessary treatment to the client, well you have a

shot

> at winning an appeal.

>

>

>

> Ultimately it is about you or your clinic/agency opting for a plan to get

> the needed services to the client, even if it is advising others of what

can

> be done.

>

>

>

> 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%40yahoogroups.com>

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

Behalf

> Of Mark Niles

> Sent: Wednesday, January 26, 2011 6:20 AM

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

> Subject: home health and out pt PT

>

>

>

>

>

> Group,

>

> Would a pt getting only wound care from a HH nurse exclude him from

getting

> out pt Pt for a different dx and body part? I am in Fl if that matters.

>

> Mark Niles PT, MS, CSCS

> Orthopedic Specialists PA

> mniles@... <mailto:mniles%40orthospecpa.net>

> x3

> fax

>

> This message, together with any attachments, is intended only for the

> addressee. It may contain information which is legally privileged,

> confidential and exempt from disclosure. If you are not the intended

> recipient, you are hereby notified that any disclosure, copying,

> distribution, use, or any action or reliance on this communication is

> strictly prohibited. If you have received this e-mail in error, please

> notify the sender immediately by telephone ( x3) or by return

> e-mail and delete the message, along with any attachments

>

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

<mailto:PTManager%40yahoogroups.com>

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

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

> Behalf

> Of Kovacek

> Sent: Wednesday, January 26, 2011 8:06 AM

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

<mailto:PTManager%40yahoogroups.com>

> Subject: Now available on PTManager.com A Manager's

Perspective:

> Part 11 OF 14 - Measurement of Outcome Information. Discussion Documents

To

> Grow Your Management Skills

>

> Now available on PTManager.com

>

> A Manager's Perspective: Part 11 OF 14 - Measurement of Outcome

Information.

> Discussion Documents To Grow Your Management Skills

> http://post.ly/1X8vK

>

> Kovacek, PT, MSA, DPT

> PKovacek@... <mailto:PKovacek%40PTManager.com>

> <mailto:PKovacek%40PTManager.com>

> Cell

> Personal Fax

>

> Twitter.com/PKovacek

> Facebook.com/.Kovacek

>

>