Re: medicare cap for hospitals

[Guest guest]

Your billing department would have access to the CWF. Ask if someone from your

department can be set up on your Medicare contractors system so they will be

able to view this information.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

http://www.gawendaseminars.com

> We are struggling with finding a tool that will allow us to pull up the

> beneficiary annual use --- if as it appears - hospitals will come under

> cap effective October 1 - I am assuming we will have to be aware of all

> beneficiary use of PT OT and ST services since beneficiary year

> beginning January 1. That to me makes it critical we be able to

> readily access the common working files or something... so far we have

> not been able to find a tool to access this info easily.... Can anyone

> make a suggestion?

>

> Laurie , Sr Director Rehabiliation Services

>

> Beaufort Memorial Hospital

>

> From: PTManager [mailto:PTManager ] On

> Behalf Of M. Howell PT, MPT

> Sent: Friday, June 01, 2012 6:15 PM

> To: PTManager

> Subject: RE: medicare cap

>

> Hi Jeff,

>

> The answer to your question lies in what services are received in a

> nursing

> home setting. Many SNF have an outpatient clinic at the facility or have

> the ability to bill Medicare Part B outpatient services. This should and

> can only be done if the resident does not qualify for rehabilitation

> under

> Part A. It would be something worth investigating, though. There has to

> be

> a medical record of outpatient PT being performed that can be copied if

> requested for the employee's father, so he and the employee can verify

> that

> Part B services were done and recorded.

>

> It doesn't matter what setting, as long as it is an allowable Part B

> charge

> and an allowable location then it counts towards the cap.

>

> Home health service do not count towards the cap HOWEVER, part B

> services

> will be denied payment if the person has not been recorded in the system

> as

> discharged from home health. An outpatient clinic needs to find out if a

> Medicare patient has been receiving home health and if they have been

> discharged at the time they are admitted to/evaluated for outpatient

> Part B

> services.

>

> That being said, home health agencies also sometimes contract or employ

> therapists that are Part B eligible and provide Part B services in the

> home.

> This may confuse the patient because the same agency that provided home

> health is now providing outpatient services in the person's home. This

> is

> done when the patient no longer qualifies for home health but still

> needs

> services in the home. Smart home health agencies have capitalized on

> this

> by having therapists that are Part B eligible contracted or on staff.

>

> It takes a good and educated office staff to track down online and by

> the

> patient what Medicare services the patient/client has actually had prior

> to

> starting a new Part B outpatient case to avoid cap problems and denials.

> If you really have concerns about the cap, use the KX modifier early to

> make

> sure that you don't get a denial for going past the cap AND make sure

> you

> document why in case you are audited in the future.

>

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

>

> IPTA Payment Specialist

>

> Meridian, Idaho

>

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

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

>

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

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

> On Behalf

> Of JEFF BROWN

> Sent: Friday, June 01, 2012 2:41 PM

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

> Subject: medicare cap

>

> I was hoping to get some clarification regarding the hospital outpatient

> Medicare cap. Specifically will the physical, occupational, and speech

> pathology services a resident receives

> while in a nursing home count against the cap allowance? This question

> was

> brought to my attention after an employee in our system got a Medicare

> EOB

> statement for her father, after his discharge from a nursing home,

> stating

> that $800 of the $1880 cap allowance had been utilized by the therapy

> services provided in the NH.

>

> One further question, is it correct that the cap does not apply to Home

> Health therapy services and therefore would not count against the cap

> once a

> patient transitions into outpatient services?

>

> Thanks,

>

> Jeff Brown PT

> Director of Rehabilitation

> Decatur Memorial Hospital

> 2300 N. St.

> Decatur, IL 62526

>

>

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