Posts: 456
Joined: October 22, 2002
From: CA
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I have been in private practise since 1985 so now many of my old patients who have had ortho surgeries want me to come to their homes to provide home PT rather any XYZ home health PT. Being Medicare Part B provider I can provide PT in the pts' home. How do I bill MCare? What are the moifiers for home? Can anyone give me some help?
Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
I'm not the billing whiz... but I believe on the 1500 claim form there is a box that indicates location of service. I would recommend that you pose your question on [URL=http://www.ptmanager.com]www.ptmanager.com[/URL] listserve. OR search the archives on that listserve.
Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
it is all very easy and legit, and using a medicare e-billing software helps. just don't have pta's seeing your pts, that is very illegal. there is no modifier because the payment is no different between home and away.
Posts: 346
Joined: March 1, 2003
From: Minnesota
Status: offline
What do you do if the patient has skilled nursing needs? I thought they would then have to go through the home health agency PT. (Can't be billing medicare for Med B at the same time). Any experiences with this?
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Joined: May 11, 2004
From: Michigan
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Holly, often times, those that are post op don't necessarily require skilled nursing needs. It's more of a convenience issue having the PT in their home for a couple of weeks before heading to an outpatient clinic... and then the driving issue... if the surgical procedure was on the right lower extremity and the person can't drive initially, it is nice for them to have physical therapy in their home. goodlooks could educate what an appropriate candidate for physical therapy in the home under Medicare B would look like and the problem is solved.
Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
i will tell you this...if you can arrange for them to get services under part A under a medicare home health agency the patients are worth a lot of $$$ to them. you can have them arrage for the patient care, there will be no co-pay for the patient in this system, and better yet, you can really charge the agency like up to about 75 a treatment and they will be more than happy. this will be the easiest route most likely.
Posts: 346
Joined: March 1, 2003
From: Minnesota
Status: offline
Actually I have been approached by an agency because they don't like working with the therapists at the local hospital (thats funny, neither did I!! ha ha thats why I went out on my own) Right now, we go into the home for TKAs or,like you say SJ, pretty much to help them out since it can be tough, especially in the winter.
Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
If I were going in, I would prefer under Medicare B. I'm not a fan of all the Medicare A paperwork. As with anything, Ben, documentation would need to support homebound. Your "easy" might be "easy" from a patient perspective, but not necessarily from the professional requirements. Copays should not be the factor that determines the service required. Often times after the surgical procedures, the patient isn't truly homebound - it's just more convenient. I've had patients and physicians ask me if I'd go in. From a business perspective and a scheduling view - I'm more productive staying in the clinic. Although, if I were working out of my home and had no Staff, it might be profitable doing outpatient in the patient's home. I would wonder how to determine when clinic treatments would be more effective and better quality than home services.
Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
If I were going in, I would prefer under Medicare B. I'm not a fan of all the Medicare A paperwork. As with anything, Ben, documentation would need to support homebound. Your "easy" might be "easy" from a patient perspective, but not necessarily from the professional requirements. Copays should not be the factor that determines the service required. Often times after the surgical procedures, the patient isn't truly homebound - it's just more convenient. I've had patients and physicians ask me if I'd go in. From a business perspective and a scheduling view - I'm more productive staying in the clinic. Although, if I were working out of my home and had no Staff, it might be profitable doing outpatient in the patient's home. I would wonder how to determine when clinic treatments would be more effective and better quality than home services.
Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
If I were going in, I would prefer under Medicare B. I'm not a fan of all the Medicare A paperwork. As with anything, Ben, documentation would need to support homebound. Your "easy" might be "easy" from a patient perspective, but not necessarily from the professional requirements. Copays should not be the factor that determines the service required. Often times after the surgical procedures, the patient isn't truly homebound - it's just more convenient. I've had patients and physicians ask me if I'd go in. From a business perspective and a scheduling view - I'm more productive staying in the clinic. Although, if I were working out of my home and had no Staff, it might be profitable doing outpatient in the patient's home. I would wonder how to determine when clinic treatments would be more effective and better quality than home services.
Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
If I were going in, I would prefer under Medicare B. I'm not a fan of all the Medicare A paperwork. As with anything, Ben, documentation would need to support homebound. Your "easy" might be "easy" from a patient perspective, but not necessarily from the professional requirements. Copays should not be the factor that determines the service required. Often times after the surgical procedures, the patient isn't truly homebound - it's just more convenient. I've had patients and physicians ask me if I'd go in. From a business perspective and a scheduling view - I'm more productive staying in the clinic. Although, if I were working out of my home and had no Staff, it might be profitable doing outpatient in the patient's home. I would wonder how to determine when clinic treatments would be more effective and better quality than home services.
Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
well said sj, lol, repeated somehow on you. Homebound is pretty loose now a days even according to medicare guidelines. As long as you aren't doing an Oasis SOC, the paperwork is really 2-3 pages max of functional eval, not too bad actually. Each PT pt is worth about 3500 to a medicare agency before costs, so if you were bringing them a patient and you charged them say 100 a treatment, even after 13 treatments, they are doing well, and you are doing as well if not better than under the part B model, once again, I agree, IF they meat the criteria for part A, but so often i see pts on part B who could easily qualify for A. Just a matter of working within the system without a matter of working the system.
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