RE: Private pay & home health

[Guest guest]

Hi ,

Please let us know what insurance coverage you are talking about: Medicare

disability? Medicare-Medicaid? Medicaid? Other insurance? There are

state rules, federal rules and insurance rules that have to be considered

and knowing the insurance helps.

Thanks

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

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_____

From: PTManager [mailto:PTManager ] On Behalf

Of Brodina

Sent: Sunday, March 13, 2011 1:24 PM

To: PTmanager

Subject: Private pay & home health

I have a home health physical therapy patient who has congenital cerebral

palsy. She is now 24 years old. She has had therapy off and on throughout

her life. Currently, her program consists of a stretching/flexibility

program, which is to be carried out by the nursing aides and family. No

functional goals for therapy at this time, other than improving her

flexibilty to prevent further contractures. The family wants and is willing

to pay out of pocket for our therapy services once a week.

My question is: due to this patient still being on caseload for home health

nursing, can we legally have this patient pay out of pocket for our therapy

services? We would have the family sign the appropriate ABN forms.

Thanks,

Brodina, MPT

Choice Therapy

[Guest guest]

Thanks .

I couldn't venture to fully answer your question because it first would be

dependent upon your state's Medicaid rules which can be very different from

Medicare rules. You definitely need to get an opinion from someone in your

state about whether your state's Medicaid rules allows you to bill

patients/families for care that is no longer covered under Medicaid rules.

In general Medicare rules will allow private payment once it is deemed that

the therapy services would be denied or are no longer reasonable and

necessary. Many private insurances have the same rules, too.

If your state Medicaid rules allow this (which would be consistent with

Medicare) then I do not see any problem with what is proposed. First be

absolutely sure that the treatment proposed is no longer a covered service.

Remember there is a disconnect between what is needed for treatment and what

insurance, in this case Medicaid, will reimburse. Just because it is not a

reimbursable service, doesn't mean it is not a necessary service. If in

your professional opinion this client would benefit from PT and as long as

it is okay within your state Medicaid rules, then go ahead and treat. I

agree with you having the family and you fill out an ABN. This is a

Medicare form but your state's Medicaid rules may require it too. I would

check on it but filling one out does no harm and is a good tool to

communicate with the family exactly what you intend and the cost.

There are others that may say that because this may not be a skilled

service, then you should not provide it. Remember, that the definition of

skilled therapy most of us use is an insurance term, not a PT term. It is

up to the professional judgment of the PT in this case to determine if this

client would benefit from continuing PT. Evidence-based medicine does apply

but that in true form takes into account the PT's experience and what the

client brings to the interaction as well as what is in the research. To me

it sounds that continuing care as proposed would be a great thing and would

prevent future complications which is as important as PT towards traditional

functional goals.

Finally, if you don't provide the service, the family may choose other

providers to do it. We are constantly complaining as a profession about the

other fields taking our business but we are equally good at giving clients

we should be treating away! If your state Medicaid rules allow it, please

consider treating this client!

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

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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 ] On Behalf

Of Brodina

Sent: Monday, March 14, 2011 10:35 AM

To: PTManager

Subject: RE: Private pay & home health

The insurance is medicaid

" M. Howell, PT, MPT " <thowell@...

<mailto:thowell%40fiberpipe.net> > wrote:

>Hi ,

>

>Please let us know what insurance coverage you are talking about: Medicare

>disability? Medicare-Medicaid? Medicaid? Other insurance? There are

>state rules, federal rules and insurance rules that have to be considered

>and knowing the insurance helps.

>

>Thanks

>

>

>

>Tom Howell, P.T., M.P.T.

>

>Howell Physical Therapy

>

>Eagle, ID

>

>thowell@... <mailto:thowell%40fiberpipe.net>

>

>

>

>

>

>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 Brodina

>Sent: Sunday, March 13, 2011 1:24 PM

>To: PTmanager

>Subject: Private pay & home health

>

>

>

>

>

>

>I have a home health physical therapy patient who has congenital cerebral

>palsy. She is now 24 years old. She has had therapy off and on throughout

>her life. Currently, her program consists of a stretching/flexibility

>program, which is to be carried out by the nursing aides and family. No

>functional goals for therapy at this time, other than improving her

>flexibilty to prevent further contractures. The family wants and is willing

>to pay out of pocket for our therapy services once a week.

>

>My question is: due to this patient still being on caseload for home health

>nursing, can we legally have this patient pay out of pocket for our therapy

>services? We would have the family sign the appropriate ABN forms.

>

>Thanks,

> Brodina, MPT

>Choice Therapy

>

>