Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ To: PTManager Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health  No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ To: PTManager Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health  No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 It is actually inappropriate to " not bill " the visit. Because in this case, the agency is basically acting as if the visit never happened. CMS clearly distinguishes between what is a non billable service, and what is not a reimbursable service. Non billable is simply what is not deemed as skilled care. Non reimbursable is a skilled service that is provided in a manner that does not warrant denial of reimbursement. A prime example of this is when some home health agencies do not bill for a visit when a PT/OT reassessment is not done at the correct visit (13th and 19th) and an assistant treated the patient on that particular visit. In your friend's example, (and this it totally speculating) it seems that the agency is bothered that they're missing out on a physical therapy case reimbursement and showing a little spite. VERY short sighted of the agency, because what if the person reinjured the hernia, then blamed it on the functional assessment by the PT, then there is no submitted evaluation. However, if your colleague didn't only do a subjective examination, and actually physically examined all of the above items you listed - independent with " up and down stairs " and " showering " etc the visit should not have taken only 20 minutes. It should take 20 minutes just  to greet a new patient, take vitals, and just simply get background HX and HPI. If the patient assessment was only subjective, and the patient stated I can do " this and that, " " no problem " and the PT didn't actually objectively examine the patient, then a " billable " therapy evaluation did not occur. You cannot document evaluating a patient and determining he/she does not need skilled therapy based on subjective information only. With your colleague's patient, you could spend 20 minutes just on educating the patient how to perform mobility and ADL's with safe mechanics/postures.  Bisesi MPT     Winter Haven, FL ________________________________ To: " geriatricspt " <geriatricspt >; " ptmanager " <ptmanager > Sent: Monday, January 30, 2012 9:16 AM Subject: Home health  Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 No, there is no minimum visit duration set by CMS to meet Medicare coverage criteria. As for the scenario as described by Wendland, there may be other factors omitted from the story which could at least inform the therapist’s compensation issue (please note that I did not say that these factors would justify it): What was the payer source (Medicare or other); what type of PT Eval was the visit (SOC/Admission or Add-on PT Eval); what was the work arrangement of the physical therapist (employee or independent contractor); if independent contractor, did the contract exclude certain visits from payment; etc.? Absent these details, the claim of fraudulent activity is probably premature. Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health & Hospice | JGEOFFRIAU@... 406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: | Fax: | Mobile: From: PTManager [mailto:PTManager ] On Behalf Of keith bisesi Sent: Monday, January 30, 2012 7:14 PM To: PTManager Subject: Re: Home health Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ From: Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> > To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 No, there is no minimum visit duration set by CMS to meet Medicare coverage criteria. As for the scenario as described by Wendland, there may be other factors omitted from the story which could at least inform the therapist’s compensation issue (please note that I did not say that these factors would justify it): What was the payer source (Medicare or other); what type of PT Eval was the visit (SOC/Admission or Add-on PT Eval); what was the work arrangement of the physical therapist (employee or independent contractor); if independent contractor, did the contract exclude certain visits from payment; etc.? Absent these details, the claim of fraudulent activity is probably premature. Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health & Hospice | JGEOFFRIAU@... 406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: | Fax: | Mobile: From: PTManager [mailto:PTManager ] On Behalf Of keith bisesi Sent: Monday, January 30, 2012 7:14 PM To: PTManager Subject: Re: Home health Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ From: Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> > To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 No, there is no minimum visit duration set by CMS to meet Medicare coverage criteria. As for the scenario as described by Wendland, there may be other factors omitted from the story which could at least inform the therapist’s compensation issue (please note that I did not say that these factors would justify it): What was the payer source (Medicare or other); what type of PT Eval was the visit (SOC/Admission or Add-on PT Eval); what was the work arrangement of the physical therapist (employee or independent contractor); if independent contractor, did the contract exclude certain visits from payment; etc.? Absent these details, the claim of fraudulent activity is probably premature. Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health & Hospice | JGEOFFRIAU@... 406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: | Fax: | Mobile: From: PTManager [mailto:PTManager ] On Behalf Of keith bisesi Sent: Monday, January 30, 2012 7:14 PM To: PTManager Subject: Re: Home health Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ From: Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> > To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Hi, - Yes. To meet CMS's criteria to qualify as a home health visit, the encounter must be at least 30 minutes in duration. For an agency to not orient a therapist to the realities of contemporary reimbursement seems sloppy. Many employers now expect therapists to work on the basis that they only pay for billable work. Dick Hillyer Hillyer, PT,DPT,MBA,MSM Hillyer Consulting Cape Coral, FL 33914 DickHillyer.com _____ From: PTManager [mailto:PTManager ] On Behalf Of keith bisesi Sent: Monday, January 30, 2012 8:14 PM To: PTManager Subject: Re: Home health Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ From: Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> > To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Hi, - Yes. To meet CMS's criteria to qualify as a home health visit, the encounter must be at least 30 minutes in duration. For an agency to not orient a therapist to the realities of contemporary reimbursement seems sloppy. Many employers now expect therapists to work on the basis that they only pay for billable work. Dick Hillyer Hillyer, PT,DPT,MBA,MSM Hillyer Consulting Cape Coral, FL 33914 DickHillyer.com _____ From: PTManager [mailto:PTManager ] On Behalf Of keith bisesi Sent: Monday, January 30, 2012 8:14 PM To: PTManager Subject: Re: Home health Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ From: Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> > To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Hi, - Yes. To meet CMS's criteria to qualify as a home health visit, the encounter must be at least 30 minutes in duration. For an agency to not orient a therapist to the realities of contemporary reimbursement seems sloppy. Many employers now expect therapists to work on the basis that they only pay for billable work. Dick Hillyer Hillyer, PT,DPT,MBA,MSM Hillyer Consulting Cape Coral, FL 33914 DickHillyer.com _____ From: PTManager [mailto:PTManager ] On Behalf Of keith bisesi Sent: Monday, January 30, 2012 8:14 PM To: PTManager Subject: Re: Home health Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ From: Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> > To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 Dick: Can you please provide me with the official reference from CMS to support your claim? Thanks. Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health & Hospice | JGEOFFRIAU@... 406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: | Fax: | Mobile: From: PTManager [mailto:PTManager ] On Behalf Of Dick Hillyer Sent: Monday, January 30, 2012 10:05 PM To: PTManager Subject: RE: Home health Hi, - Yes. To meet CMS's criteria to qualify as a home health visit, the encounter must be at least 30 minutes in duration. For an agency to not orient a therapist to the realities of contemporary reimbursement seems sloppy. Many employers now expect therapists to work on the basis that they only pay for billable work. Dick Hillyer Hillyer, PT,DPT,MBA,MSM Hillyer Consulting Cape Coral, FL 33914 DickHillyer.com _____ From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On Behalf Of keith bisesi Sent: Monday, January 30, 2012 8:14 PM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: Re: Home health Is there even a specified time quota for home health visits per CMS? Bisesi MPT Winter Haven, FL ________________________________ From: Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> <mailto:rbarbato%40emrmc.org> > To: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> Sent: Monday, January 30, 2012 10:13 AM Subject: RE: Home health No, plain and simple PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 Dick , To clarify my answer was directed at the question: " ....is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? " Which I was hoping would lead to another question, should this patient have been referred at all? Would a nursing/provider screen have been better> Ron Barbato PT Administrative Director, Rehabilitation Services rbarbato@... PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 This is my understanding, Cms expectation is that in the aggregate therapy visits average 48 minutes but no regulation. Min time to bill is 8 minutes. Bob Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 The matter of 48 minutes average duration per therapy visit is the result of an extensive retrospective study that CMS commissioned in preparation for the home health payment change from cost reimbursement to IPS then to PPS which became effective in 2000. This study found that the average duration of home health therapy visits was 48 minutes. CMS then arbitrarily posited that 480 minutes, or by proxy, 10 visits of combined therapy (PT, OT, SLP) within each 60-day episode of care would serve as the threshold to secure the add-on therapy payment. In 2008, mostly due to unethical practices driven by payment incentives, this single threshold of 10 therapy visits was replaced by multiple thresholds with corresponding triggers for incremental add-on payments of a regressive mode. There is neither a regulation nor an expectation from CMS that the average duration of therapy visit should remain at or around the 48 minutes level. There is also no regulation stating that a visit of less than 8 minutes of duration would not be covered and thus not billable, although it would be very difficult for either a therapist or a home health provider to justify doing so. However, such occurrences of very short visits might possibly trigger closer scrutiny from the local Medicare Administrative Contractor (MAC, previously known as Fiscal Intermediary or FI) through post-payment audits via Additional Documentation Requests (ADRs). Most electronic documentation software modules for home health have internal alerts which can reject visits shorter than 15 minutes from billing until such short visits have been verified for accuracy of the declared duration. If the documentation for a very short visit demonstrates that some skilled care was provided in accordance with the plan of care, and there is also a documented plausible explanation for the short visit, then the visit would be covered and billable. If anyone wishes to correct me, please do provide me with the specific link to the appropriate home health regulation from CMS. I am always willing to learn... Thanks. Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health & Hospice | JGEOFFRIAU@... 406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: | Fax: | Mobile: From: PTManager [mailto:PTManager ] On Behalf Of Bob Tripicchio Sent: Tuesday, January 31, 2012 12:45 PM To: PTManager Subject: Re: Home health This is my understanding, Cms expectation is that in the aggregate therapy visits average 48 minutes but no regulation. Min time to bill is 8 minutes. Bob Home health Hi All: asking for a friend: A home health PT eval lasted only 20 min because the patient was recently post-op hernia repair, but independent functionally without assistive devices, including up and down stairs and showering. This was an eval-only, no further PT needs. The home health agency refused to bill the visit, and refused to pay the therapist, stating all visits must be at least 30 min. This seems wrong, possibly fraudulent to me. After all pertinent tests are performed and the patient is not deemed a candidate for home health PT, is the therapist really expected to sit with the patient for another 10 min just to reach an arbitrary time quota? Wendland PT Ohio Sent from my iPhone The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance. Dedicated to Hope, Healing and Recovery. ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and your location or else your message will not be approved to send to the full group. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our professions. PTManager is not available to support POPTS-model practices. The description of PTManager group includes the following: " PTManager believes in and supports Therapist-owned Therapy Practices ONLY " Messages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. PTManager blog: http://ptmanager.posterous.com/ Quote Link to comment Share on other sites More sharing options...
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