Home Health and OP PT Question

July 17, 2012

I have always understood that if a person was receiving home health they

could not receive outpatient physical therapy at the same time under

Medicare rules. I had a call from a clinic today saying they have a patient

who had a device implanted into his abdomen to help keep his heart beating.

It is not a pacemaker but I can't remember the name of it. He is currently

having home health come out three times a week to draw blood for his INR,

but he is having therapy at the outpatient clinic. The clinic has been told

they can bill for cardiac rehab while he is receiving home health. Is this

true and if so what is the proper way to bill it to be covered as cardiac

rehab?

Becky A. Sewell, MRC, CRC

Rehab Net of AR/ArPTA

P.O. Box 202

Conway, AR 72033

ph/fax

Check our website for continuing education opportunities for PTs, OTs, and

SLPs at www.RehabNet-AR.com

July 18, 2012

A Medicare beneficiary can receive both home health and outpatient therapy at

the same time. However, due to the Medicare Consolidated Billing provisions for

home health coverage, Medicare will not pay the outpatient therapy provider so

the OP therapy provider needs to discuss the patient's needs and possibly enter

in a mutually agreed contract for payment to be made by the home health provider

to the OP therapy provider. This scenario seldom comes into play unless the

home health provider is unable to provide the therapy services, either because

of staffing issues or because the therapy procedure cannot be provided in the

home setting (e.g., decongestive lymphedema therapy by PT, invasive continence

therapy by PT or OT, fluoroscopic MBS study by SLP). In the absence of such a

prior agreement, the home health provider has no obligation to pay, and the OP

therapy provider has no payment source. The contract would allow the home

health provider to integrate the OP therapy POC in the overall home health POC,

secure copies of the OP therapy clinical notes (according to home health

criteria), declare the OP therapy visits for billing Medicare, and pay the OP

therapy provider according to contract.

Both true outpatient Cardiac Rehab and Pulmonary Rehab are excluded from the

Medicare Consolidated Billing provisions for home health. Cardiac Rehab and

Pulmonary Rehab are clearly defined programs by CMS with their own specific

certification and coverage criteria. However, there are two related concerns to

consider: (1) Some Cardiac Rehab and Pulmonary Rehab providers " add " some OP

therapy procedures to their plans of care and these procedures would not be paid

by Medicare as they would be included in the Consolidated Billing provisions;

(2) If the patient is leaving the home so frequently as needed to participate in

a Cardiac Rehab program, it may invalidate the homebound status and thus

jeopardize the home health coverage. My experience is that most patients

qualifying for OP Cardiac or Pulmonary Rehab are first discharged from home

health.

Hope this is of help.

[cid:image001.jpg@...]

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

Becky Sewell

Sent: Tuesday, July 17, 2012 2:42 PM

To: PTManager

Subject: Home Health and OP PT Question