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Medicare and in-home PT question
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Medicare and in-home PT question - October 8, 2008 7:04:09 PM
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PTupdate.com
Posts: 1474
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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A relative of my wife is being released from short period in nursing home, and they prefer I come and provide her PT treatment for gait (Parkinson's) and foot injury.
While I know I can do this under Part B benefits, and there are no other home services being provided, does this route "screw up" anything if she needed more intense home treatment down the road, such as nursing, etc? Is there some weird Medicare window of opportunity that has to be satisfied first?
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Medicare and in-home PT question - October 8, 2008 9:45:12 PM
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SJBird55
Posts: 2430
Joined: May 10, 2004
From: Michigan
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Under Medicare B, as long as she is a candidate for outpatient services and will improve in a reasonable amount of time with skilled services that are reasonable and necessary, physical therapy services are appropriate whether they are provided in the home or in an outpatient setting. On the claim form, the location code needs to indicate the services were performed in the home.
Home health is under Medicare A. Medicare A and Medicare B physical therapy services cannot be performed/provided concurrently. To my knowledge, I do not believe there is some regulation that would impede her from receiving Medicare A services upon your completion of providing Medicare B services. I've had patients begin services with me and then have a substantial change in function and immediately begin Medicare A services. Think dialysis and then needing a feeding tube... think a fracture as a result of a seizure... think someone who is dependent on others to attend Medicare B PT and has horrible attendance because of dependency and hardship.
What you need to think about is... you are filing a claim for the provision of services... who will Medicare B reimburse. Since you are in outpatient PT, right now you probably have your NPI tagged with your employer and a re-assignment of benefits going to the employer. I believe the employer will also tag a business NPI on the claim also. So, for the claims submitted by your employer your NPI is identified with the company NPI. I'm not sure how you complete your claim to indicate that you would like to be paid directly... OR if you just go through your employer and the employer pays you? Something to work out before filing a claim.
- edit.. and then, put some thought into liability. What kind of liability coverage to you have? Will it cover you everywhere and anywhere? Is it only for in the clinic? Not that your in-law would necessarily sue, but you do have to know that information too - only you can protect yourself and you need to know what you have and your options in that area.
< Message edited by SJBird55 -- October 8, 2008 9:52:13 PM >
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