Homecare under Medicare part B (Full Version)

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Ed -> Homecare under Medicare part B (May 17, 2008 12:39:53 PM)

I'm interested in providing physical therapy for homebound Medicare patients under part B Medicare coverage. Will medicare reimburse  me as a sole proprietor or should I be a certified home agency to be able to get such a reimbursement?



SJBird55 -> RE: Homecare under Medicare part B (May 17, 2008 1:24:01 PM)

Homebound patients who are Medicare beneficiaries actually meet Medicare A guidelines.  From what I have been told, there is less financial responsibility for patients receiving physical therapy services under Medicare A in their homes.  Home health agencies provide Medicare A physical therapy services.

If a patient is not homebound and are Medicare beneficiaries, then they do not meet Medicare A guidelines.  For this circumstance, physical therapy services are provided on an outpatient basis under Medicare B.  Services CAN be rendered in the patient's home as the location of services and billed under Medicare B.  I assume you would bill the services out under your NPI.



Ed -> RE: Homecare under Medicare part B (May 17, 2008 6:29:09 PM)

Thank you for your prompt reply. Do you have any idea where can I find the information about Medicare regulations regarding services provided at home as the location of services under part B ?



SJBird55 -> RE: Homecare under Medicare part B (May 17, 2008 6:57:47 PM)

This could be a start:  http://www.cms.hhs.gov/MLNProducts/downloads/Therapy_02-05-08.pdf

Peter Kovacek co-owns In Home Rehab:  http://www.ptmanager.com/starting_a_new_therapy_practice.htm  I would assume that if you went that route, you'd share a certain percentage of your profits with the owners of In Home Rehab.



PT4TOTS -> RE: Homecare under Medicare part B (May 26, 2008 4:11:24 PM)

Hi,
To receive home based Pt under medicare A from a home health agency, dont the patients have to be discharged home from the hospital with a minimum 3 day stay. I thought this was the only way that a patient qualifies for home based PT under medicare part A. In all other cases, I thought the therapy services were to be billed under Part B.

If a therapist were to bill home based physical therapy services under part-B, how would the patient get the script from the MD and what is the most common way for a therapist to build a home based practice. Word of mouth by patients or by cold calling/visiting physicians offices letting them know such services were available.



SJBird55 -> RE: Homecare under Medicare part B (May 26, 2008 4:36:50 PM)

Skilled nursing facilities under Medicare A have some rule with regard to discharge from a hospital.

Home health services billed under Medicare A do not require a hospital admit.  The Medicare beneficiary is required to be homebound to meet home health benefits.

If the patient would be considered homebound, the physician writes the referral for physical therapy services and then typically the person that does referrals in the office sets up the home health services by contacting the home health agency. 

I would suppose if a physical therapist focused on physical therapy services provided in the home billed through Medicare B (for beneficiaries not meeting homebound requirements), the therapist would need to get the word out in the community and with the various physicians in the area.  In my opinion, the slick way to reduce drive time would be to actually reach out to assistive living facilities and/or senior community living situations.  If a PT were able to have a patient load of 3-4 patients at a couple of assistive living facilities in a close radius, the cost of doing business could be substantially reduced - drive time and gas while productivity could be increased.



PT4TOTS -> RE: Homecare under Medicare part B (May 26, 2008 5:15:31 PM)

You make a very good point. Thank you for your response.



Buckeyes93 -> RE: Homecare under Medicare part B (June 10, 2008 11:51:38 AM)

Medicare will reimburse you to go out and do it on your own under part B.  I believe they will as a sole proprietor but you can check on the application for your provider number to be sure.  The form you'll need to fill out is the CMS 855-I.  You may also want to consider creating another legal entity such as an LLC (very inexpensive and easy to do on your own) to create a separation from your personal.  You will also need to fill out CMS 855 B as well as direct deposit etc.  I do PT consulting so am very familiar with the processes.  Good idea that is very underutilized by PT's.  We do in central Ohio but takes time educating MD's and their staff.



SJBird55 -> RE: Homecare under Medicare part B (June 11, 2008 12:52:10 AM)

With Medicare reimbursement rates and no payment for drive time or gas, I don't know if providing Medicare B services in the home is really a good business decision.  There is a 10% cut looming in the near future, unless Congress stops it.  One should definitely know overhead costs and attempt to provide services for patients in need in a close proximity, in my opinion.  Know your breakeven point and if productivity above that level can consistently occur and at what level the above breakeven poiont can be maintained.



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