Home based outpatient therapy (Full Version)

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nmueller13 -> Home based outpatient therapy (April 23, 2006 12:32:00 PM)

Hi. I'm thinking of starting a homed based outpatient practice. I wanted to know if anybody out there has done this and if they can provide any pointers. I've looked into In Home Rehab and they seem pretty good (anybody have experience with them?) It seems daunting to try to do it without help. For now, it'll just be me working out of my house. Thanks for any advice.



MickeyPT -> Re: Home based outpatient therapy (April 23, 2006 2:29:00 PM)

I'm new to this concept but it sounds intriguing. It sounds like you would have patients come to your house for treatment. Would you just section off a part of your house as a facility or erect another structure on the property? Zoning laws would definitely need to be researched. What patient population would you be targeting? Do you have a family that lives at this residence? I'm not so sure I would want to have a steady flow of strangers coming to the home of my wife and children.

Perhaps your home based practice would be for home health. I would be much more supportive of this practice. Little overhead and no rent. Two highly desirable business qualities.

Please elaborate.



nmueller13 -> Re: Home based outpatient therapy (April 23, 2006 3:40:00 PM)

Sorry if I wasn't clear. I would go to patient's homes - imagine the nightmare if they came to mine!! I'd have a home office for documentation, billing, etc. No need for office space in a traditional sense.

What I was really looking for was input on how to start a business like this. As far as billing goes, how would I do that myself? Should I outsource that? Get software that does it? I guess just the normal start up stuff. Should I work with consultants? I'm trying to decide between doing this all on my own and working with consultants that have a start up fee and then monthly fees based on revenue - but they help with billing, documentation, marketing, compliance issues, etc. Thanks in advance for any help.



FLAOrthoPT -> Re: Home based outpatient therapy (April 24, 2006 2:52:00 AM)

do it all on your own. MArketing is not hard nor is it expensive, get a medicare number and start sending in your claims. I did this as well, but I did not even g the whole medicare route, I just took cash for treatment, I guess it depends on where you are. Get two or three PTAs, pay them well, have them do the treat you do the evals and management. Easy business, lots of people doing it down here in south fla..
Ben



Jeffre -> Re: Home based outpatient therapy (April 24, 2006 10:34:00 AM)

It really just sounds like starting your own home health company. What would be the difference between home health and this?With my company we bill the home health agency directly $60-65 per visit. Don't know how much you would get reimbursed billing medicare as I am not involved in billing at my hospital based OP clinic. If you are full time you could have about 40 visits per week. If you have a PTA double that.



nmueller13 -> Re: Home based outpatient therapy (April 24, 2006 2:33:00 PM)

Thanks for the input. Are you sending in your claims electronically? What kind of software do you use? I would love to take cash for treatment but I'm not sure if there is that kind of market in NJ. In south fla, are many people paying cash?

The difference b/t home health and this is that the payor is Medicare Part B not part A. Do HHAs only bill part A, i'm not that familiar with how they bill. I would essentially be providing outpatient PT to people in their homes.



KIDPT23 -> Re: Home based outpatient therapy (April 25, 2006 5:25:00 AM)

You have to set up your company a certain way to be able to do this..you can not just name your company, get your LLC. or inc., get your tax id number and go at it. In order to get your tax id number they will require you to have your permit for your building that you will be based out of. If you open as a basic outpatient center then you a limited and only allowed to practice out of the clinic(within the clinic walls) ...unless you open as a CORF which will allow you to go into peoples homes and treat with all the billing going the home clinic that you get your permitting and licensing thru. CORF gives you the most freedom to practice but are under the most intense eye of medicare. Look into all aspects and know your state practice laws.



matotoms -> Re: Home based outpatient therapy (April 27, 2006 3:42:00 AM)

[QUOTE]You have to set up your company a certain way to be able to do this..you can not just name your company, get your LLC. or inc., get your tax id number and go at it. In order to get your tax id number they will require you to have your permit for your building that you will be based out of. If you open as a basic outpatient center then you a limited and only allowed to practice out of the clinic(within the clinic walls) ...unless you open as a CORF which will allow you to go into peoples homes and treat with all the billing going the home clinic that you get your permitting and licensing thru. CORF gives you the most freedom to practice but are under the most intense eye of medicare. Look into all aspects and know your state practice laws. [/QUOTE]completely wrong, unless they changed the rules last year. The only benefit you get from a CORF is relaxed supervison of PTA rules. If you are a PTPP, you need to be within the same building as a PTA ...as a CORF you do not. SO for medicare billing a PTPP cannot send a PTA into peeps homes unless they go there with them to supervise.



coryblick -> Re: Home based outpatient therapy (May 6, 2006 2:24:00 PM)

FLAOrtoPT,
When you do your in home services, do you have staff with you? Is there concern if a client makes an accusation against you? Has this been a concern for you? If so, how have you addressed it?
Cory



FLAOrthoPT -> Re: Home based outpatient therapy (May 7, 2006 2:51:00 PM)

When i do private cash paying i do it by myself. Otherwise I go through a CORF. I have in my other business over 150 therapists and in 5 years I have only had one lawsuit, and it was dismissed. I am not so sure why everyone is so litigation scared?
Ben



matotoms -> Re: Home based outpatient therapy (May 8, 2006 7:19:00 AM)

[QUOTE]If you open as a basic outpatient center then you a limited and only allowed to practice out of the clinic(within the clinic walls) ...unless you open as a CORF which will allow you to go into peoples homes and treat with all the billing going the home clinic that you get your permitting and licensing thru. CORF gives you the most freedom to practice[/QUOTE]are you standing by your theory that only a clinic operating as a CORF can go into peeps homes?



KIDPT23 -> Re: Home based outpatient therapy (May 8, 2006 10:33:00 AM)

You can on a very limited basis as a rehab agency or ORF, but there is much grey area. The only way I see that you can without risk is if you file as a home health agency which I am not aware of since i do not do that. My outpatient center is not ORF or CORF and my attorney looked in to the guidelines of one of my therapists going into the home environment and it was not recommended. Even if we went in as a cash based situation, you are still putting yourself in a risky situation if something were to go wrong while you were performing the treatments. To me it is not worth it either since you have driving time, gas, seeing only 1 person in a hour all thrown into it compared with me seeing 2-3 patients in a hour. Do not see the benefit into it.



bhenchodh -> Re: Home based outpatient therapy (May 8, 2006 11:42:00 AM)

My two bits: Medicare Part B allows you to see patients at their homes. All you need is a Medicare provider number. Yeah you can open an LLC, corp. whatever but bottom line is you treat patients in home like you treat them in clinic. You goals and treatment plan need to reflect that. Don't select goals that a home care PT would because that reflects that patient would benefit from home care PT (under Part A). Truly assess your patient's problem list and goals. If the patient needs home care (goals related to bed mobility, sit to stand transfers, feeding self, showering transfers, versus goals related to pain in low back with ambulation, difficulty with stairs, etc.) then refer to a home care agency. Now this doesn't always apply to all insurance agencies, like Healthnet. Remember to have a prescription for all insurances requiring prescriptions, and biweekly plan of care updates to a physician after 30 days of treatment if following direct access in NJ. Get his signature on your plan of care. Patient's home bound status is not necessary for reimbursement under Part B. Also link yourself to physicians who do housecalls themselves. Thats easy to find out by just callling all the geri/family docs and asking the front desk. Good luck. Home based therapy is great for a more relaxed/ flexible work environment, and focusing on more neuro/ geriatric population based clientele.



bhenchodh -> Re: Home based outpatient therapy (May 8, 2006 11:58:00 AM)

Also for those seeing 2-3 patients per hour in a clinic, no offense but you cannot compare in home therapy kind of business to clinic based business. They are totally separate entities. Money wise yes you can make a lot of money in the clinic but look at your overhead costs, setup costs, etc. With home based business your overhead cost is low, very low. Why I am saying all of this is because currently I provide both in home therapy and I have a private practice. Ideally if my practice reaches its full potential it totally beats in home therapy in many ways (gas, my back from sitting in the car all day long, traffic, people's houses are not always clean, pets, inclement weather etc.), but I could have never opened my clinic without two years of solid savings from in home therapy and HHA independent contractor jobs. Bottomline is in home therapy can be very profitable. Just market yourself well, invest in some basic equipment (email me and I'll give you a whole list of what I purchased), get an efficient car and you can easily make 80-120K per year without clinic headache. It also preps you for your own outpatient clinic business. I have a clinic because I like that kind of environment more than in home therapy. Another piece of advice: get self insured for not only full time physical therapy, but also review general liability insurance for off-site practice by talking with your malpractice insurance rep.



nmueller13 -> Re: Home based outpatient therapy (May 8, 2006 5:17:00 PM)

Thanks for the advice, AHAwkins. The other posts were making me a little skeptical. From all the research that I have done I was under the impression that I would just need to follow the usual medicare part B guidelines (as you said). Did you start out with a home office? and if yes, did you use that address on your letterhead and other business forms? What is your email? I'd love to get your equipment list - i made one up already but I need as much input as possible. Would you mind if I emailed you some other questions? Thanks again.



FLAOrthoPT -> Re: Home based outpatient therapy (May 8, 2006 6:16:00 PM)

actually re read these posts they are actually very correct. You cannot send a PTA into a home unless you are an ORF, CORF or rehab agency. All very hard to become. If you yourself are going in a home, then yes, no problem, but do not send PTAs in a home. Home health care is much more lucrative just contracting yourself out per visit to do medicare A evaluations. you can usually do a bunch of them in a short itme in an ALF and get up to about 65 per eval. When you break this into an hourly rate, you can do much better and no risk rather than collecting 90 net from medicare and spednign all that time at a house and time billing. So find an agency that contracts with a bunch of home health agencies and become a PT evaluator. you'll make on average about 85-100K a year with no overhead, write all car expenses off through your corp, and be stress free.
Tootles-
Ben



matotoms -> Re: Home based outpatient therapy (May 9, 2006 6:07:00 AM)

[QUOTE]actually re read these posts they are actually very correct. You cannot send a PTA into a home unless you are an ORF, CORF or rehab agency.[/QUOTE]they are correct now ...mostly...now that you deleted or edited your prior post, which in fact was incorrect. Admitting a mistake can be tough for some people i guess, not sure why .... its quite trivial.

[QUOTE]If you open as a basic outpatient center then you a limited and only allowed to practice out of the clinic([bold]within the clinic walls[/bold]) ...[bold]unless you open as a CORF which will allow you to go into peoples homes and treat[/bold] with all the billing going the home clinic that you get your permitting and licensing thru.[/QUOTE] [QUOTE]You cannot send a PTA into a home unless you are an ORF, CORF or rehab agency. All very hard to become. If you yourself are going in a home, then yes, no problem, but do not send PTAs in a home.[/QUOTE]only true for medicare folk and ins companies that restrict PTA services, ala tricare. trivial maybe,,,but correct.

to the OP,, these rules are so extremely well written and layed out in the medicare manuals that is is entirely amazing that there is any conflict as to what the 'truth' is. The amount of misinformation, even if trivial, is insane and unnecessary. You will need to know these guidelines/rules and should keep a copy of the appropriate section of the manual in your P and P.

if you spend an hour at medicare.gov you will find the appropriate sections that relates to PTPP and CORFs, all the rules governing them, how to sign up, etc and you will also find paperwork/documentation regs that is the key to surviving an audit. If in florida , be sure to go to floridamedicare.com? or just do a google for LMRPs for the state you are in...these local medical review policies mostly reiterate the federal medicare rules, but there might be small variations that would be key in case of an audit, and these LRMPs trump the federal guidelines....In the end its all about the documentation if you want to hold onto the money that you spent hours dealing with patients and greasing doctors to accumulate.



Jeffre -> Re: Home based outpatient therapy (May 9, 2006 7:02:00 AM)

It really seems to come down to what type of pt population you want to deal with. With home health you will see an older population with mostly deconditioning, s/p surgery, gait abnormality, OA and some s/p joint replacement Dx. With the in-home OP it seems more the type of OP people we are used to seeing. I like home health. Set up your company, get some contracts with home health agencies charging $55-65/ visit, a cell phone and you are good to go. I still do joint mobs, higher level ther ex and balance things for home health so its not like I'm doing bed mobility and transfers all day. We don't have to worry about if our PTA can go into a house or not. You also don't have to fight insurance companies for reimbursment. The biggest headache we have is when the home health companies lose notes and then say we didn't send them and they won't pay us until they get them.



nmueller13 -> Re: Home based outpatient therapy (May 9, 2006 10:37:00 AM)

Thanks again everyone. I'm not planning on sending a PTA into homes (I don't think it's allowed in NJ). As far as the population, I am looking for the geri/neuro pop and some post surgical pts. I'm not an ortho. pt but I do like the high level balance and some joint mob (I don't want to do bed mob and transfers all day.. more gait training and balance, NDT, vestibular!!). I'm not looking for the back/neck population or sports injury types. SO Jeffre, what you're saying is to become an independent contractor for HHA? Would there be a conflict if I was working for a HHA and also marketing for my own patients? That wouldn't be a bad way to start - i could phase out the HHA as my own practice grew. Something to think about...

mt, i have spend a lot of time on CMS and APTA's websites and have found a lot of useful info. I'm not too worried about documentation (the place i currently work at is very "by the book" so I know how to do it the right way). I'll have to check out our LMRP for their variations, if any. From all that I've researched I can set up as PTPP without a problem.

I appreciate all the advice. Keep it coming!!!



FLAOrthoPT -> Re: Home based outpatient therapy (May 9, 2006 1:50:00 PM)

MT not sure what crawled into you boxers that morning? really now? I think we are all agreeing here and having a useful discourse, not sure where your gruff nature is coming from. I have not edited one single post, nor has anyone, nor would it even matter?!?! All I was saying, is that I had skimmed the previous posts, and having read them thoroughly, I agree with everything being said, including my own advice. Not sure if you are short in stature and have come napoleon complex thing going on, or are just bitter to the world, but lighten up guy, no one was starting anythhing with anyone?
Love,
Ben
ps this post has been edited three times both before you read it and since you have replied



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