Home health outpatient therapy often conflicts with outpatient therapy financially, leaving providers to wonder how to figure out if a patient is in a home health plan of care. There is a misperception on the rules of home health therapy and how it affects traditional outpatient therapy. Let’s take a look at the different aspects of home health:
- Home health provided under a home health plan of care and paid for by Medicare Part A
- Home health provided under a home health plan of care and paid for by Medicare Part B
- Home “outpatient therapy” paid for by Medicare Part B, provided by a home health agency or a private practice
Outpatient therapy clinics want to know if a patient is receiving home health therapy, more accurately put – is the beneficiary under a home health plan of care? A patient may be referred to outpatient therapy, arrive at your clinic with a script for outpatient therapy and tell the admissions person that they are not receiving home health. If a patient is under a home heath plan of care, outpatient therapy claims will be rejected for that time period. How does this conflict happen? Most often a patient is asked about home health physical therapy. The patient will indicate they are not receiving physical therapy at home, and may also indicate if they had been recently discharged from physical therapy. If the home health agency is still providing nursing services, then all eligible services must be provided through the home health agency. Or alternatively all home health services have been completed but the home health agency has not sent a discharge notification to Medicare.
A home health plan of care can be indicated by #1 or #2 above. In order to qualify for home health provided under Part A, the beneficiary must have had a recent 3 day hospitalization (inpatient, not observation), have Part A benefits, and have been discharged within 14 days from either the hospital or a skilled nursing facility in which the “individual was provided post-hospital extended care services.” If the first home health visit is within 14 days of discharge, then financing is under the Part A benefit. Once the Part A visits (100) are exhausted, medically necessary home health (under a home health plan of care) can continue under Part B. Read up on home health coverage in the Medicare Benefits Policy Manual Chapter 7.
What is Home Health Outpatient Therapy
A new trend in home health outpatient therapy is burgeoning. This is outpatient therapy where the therapist provides therapy in the beneficiary’s home. Home health outpatient therapy refers to a home health agency providing outpatient therapy, billed to Part B, in the beneficiary’s home. This therapy is not under a home health plan of care, but rather an outpatient therapy plan of care. Reimbursement is per the Medicare Physician Fee Schedule, and no more reimbursement is given than that to the neighboring therapy clinic. There is no adjustment, or charging for transportation to and from the home. The trend is to provide therapy services in homes in geographically tight senior communities, independent living apartments and assisted living facilities. Traditional outpatient clinics are expressing an interest in providing therapy in the home, but as outpatient therapy, not as a home health agency or under the home health benefit. We will have more information on this in a future post, but a brief discussion here was needed to contrast outpatient therapy in the home with home health therapy.
Are you getting a better understanding of the variances in the term “home health outpatient therapy” ? Does this clear things up when you are looking at outpatient admission? Or how about the curiosity you’ve had about providing traditional outpatient therapy in a patient’s home or residence? How is your clinic verifying if the patient is currently under a home health plan of care that will preclude you getting outpatient therapy reimbursement?
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